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, <br /> ' everett ,,e. -''' � ^'. <br /> � , � ' r �. <br /> / V •.+� "''�,'�..' �}�. � <br /> s■F <br /> �� � , <br /> ,,- <br /> City of Everett <br /> Enpneerin� Dep�rtment <br /> Sewer Application and Permit <br /> N0. C 12 .i O DATE <br /> Service Address_ Utility Account No. <br /> Billing Address Connection Permit Fee_: - <br /> City, State, Zip - Connection Fee <br /> Osvner (Mortgagor) - � Total Fee <br /> Billing Name <br /> Connection By <br /> Aodress _ Signed <br /> cu:comer <br /> Phone ' <br /> DESCRIPTION: Sewer District <br /> Lot <br /> Block Monthly Sewer Service <br /> Division or Addition Monthly Sewer Constr. <br /> Type Permit: . Trunk <br /> Lateral <br /> Remarks: T-G <br /> Abutting Lot Line <br /> N, S, E, W ft. <br /> Approved By <br /> City Enyinen <br /> Issued By <br /> Inspection By <br /> 0 <br /> Date Inspected —z — <br /> SEE SKETCH ATTACHED N0. ;�1 ? 3 Q <br /> �r�l��P�CI I�]f; <br />