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a <br /> eveiett � . , <br /> e ,_ _- ,� _ 7 s - <br /> I ::�:�_ ,�i _ 7 � _ S— <br /> City of Everett I <br /> /._'�',./� <br /> Enpineering Depertment � <br /> �r� <br /> Sewer Application and Permit <br /> N0. 2 _L 1 J;. DATF. ' , - <br /> Service Address ' Utility Account No. <br /> Eilling Address <br /> Connection Pennit Fee <br /> City, 3tate, Zip Con��ection Fee <br /> Owner (Mortgagor) Total Fee <br /> Billing Name <br /> Connection By � <br /> Address • Signed. <br /> � . � - - ' Cwtomer <br /> Phone <br /> DESCRIPTION: � <br /> Lot <br /> Sew� District <br /> Block Mor�hly SewerService <br /> Division or Addition - Moc 'dy Sewer Constr. <br /> Type Permit: Trunk <br /> Lateral <br /> Remarks: <br /> � ' - Abutting Lot Line <br /> N, S. E. W ft. <br /> N/= C' ic= ' � r - `2. oc�7` �,C1G�/� '4PProved By <br /> Qty Engineer <br /> Issued By <br /> Inspection By - � <br /> e Date Inspected <br /> SEE SKETCH ATTACHED N� � .I .1 5 � <br /> ' ',":�;flUiv <br />