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everett � <br /> � /� /`% �%,S" � �� <br /> , <br /> rr� '' <br /> ; <br /> City of 'cverett <br /> C�ngineermg D!�partment ��( <br /> S�e,�wer f�►p��icat�o��� and �ermit <br /> N0. _ ._ DATE _ <br /> Service Add,�ess Utility Account No.__ <br /> Billing Adrjress _ Connection Permir ree --- -- <br /> Cit�, State, Zip Connection Fee �G� �/��.C�Z{ ' <br /> �nc� <br /> Owner (Mortgagor�_ Tetal Fee_ _ 3� <br /> 3illirg Name__ _ <br /> Connection By_ <br /> Address Signed <br /> Cu:domer <br /> Phone <br /> DFSCRIPTION: Sewer District �i..�r� -� � ` <br /> Lot <br /> E31ock Monthiy Sewer Service <br /> Division or Addition _Monthly Sewer Constr. <br /> Type Permit: Trunk <br /> Laterel <br /> Remarks: <br /> Abutting Lot Line <br /> _l��PF•P %�f'ETcf/. N, S, E, W ft. <br /> Approved By_ <br /> _ �ity Enginecr <br /> Issued By <br /> Inspection By�' - ��' - - ^ <br /> / j <br /> o Date Inspected j/-2o- _ <br /> SEE SKE7CH F.TTACfiED N0. <br />