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' --� <br /> ev�rett - <br /> � <br /> � � ��`_� �`-- �— <br /> �� ✓ <br /> City of Everett <br /> Engineering Department , <br /> Sewer Application and Permit <br /> NO. G _L J t� �:) 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 /> Address Signed <br /> Customer <br /> Phone <br /> DESCRIPTION: Sewer District <br /> Lot ' ' <br /> Monthly Sewer Servir,e <br /> Block <br /> Di� ision or Addition_ Monthly Sewer Constr. <br /> Trunk <br /> Type Permit: <- r,t l <br /> Lateral <br /> Remarks: <br /> _ Abutting Lot Line <br /> N, S, E, W ft. <br /> Approved By <br /> Ciry Ene��eer <br /> Issued By <br /> �1,4tn�,���a�Nso� <br /> Inspection By �_�'� � E'�r �,. �G <br /> Date Inspected -���- <br />