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,r-- . -; <br /> everett ;r`✓ y��� �-- .,� -. <br /> � (�`-.---- ' F ..;2� ti- <br /> f. <br /> City of Everett <br /> Engineering Department <br /> Sewer Application and Permit <br /> N0. G I -i ; � DATE <br /> Service Address Utility Account No. <br /> Billing Address Connection Permit Fee <br /> City,State, Zip Connection Fee <br /> Owner (Mortgagor) ' Total Fee <br /> Billing Name <br /> Connection By ' <br /> Addf855 � � Signed Customer <br /> Phone <br /> DESCRIPTION: Sewer District <br /> Lot Monthly Sewer Service <br /> Block <br /> Division or Addition Monthly Sewer Constr. <br /> Trunl:_ <br /> Type Permit: <br /> Lateral <br /> Remarks: Abutting Lot Line <br /> N, S, E, W ft. <br /> .-,�.��1� <br /> Approved By <br /> Ciry Engineer <br /> Issued By <br /> Inspection By_,����/ -�.�"��`—� <br /> Date I nspected_ ��/�7�j� <br /> a <br /> SEE SKETCH ATTACHED NO. ? I_ � 7 (_i <br /> �f'..� ..JII�� , � <br />