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� <br /> everelt <br /> � � �,< ; - - . ;� <br /> M _�_1 — <br /> Z`�—S <br /> City of Everett <br /> Engineering Department <br /> Sewer Applicction and Permit <br /> N0. i �. J f' -r DATE <br /> Service Address Utility Account No. <br /> Billing Address Connection Permit Fee <br /> City,State, Zip Connection Fee <br /> Owner IMortgagor) Total Fee <br /> Billing Name <br /> Connection By <br /> Address Signed <br /> cu:tortrer <br /> Phone <br /> DESCRIPTION: Sewer District <br /> Lot <br /> Block Monthly Sewer Service II <br /> Division or Addition Monthly Sewer Constr. <br /> � <br /> Type Permit: Trunk I <br /> Lateral <br /> Remarks: <br /> Abutting Lot Line <br /> N, S, E, W ft. <br /> Q0 � <br /> Approved By <br /> City EnBineer <br /> Issued By <br /> Inspection By '�� �j-e�'�-��--= <br /> B Date Inspected i ��� y�J` <br /> SEE SKETCH ATTACHED N0. � _1_ r� < i`'. <br /> f CCII�)�i <br />