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everen <br /> e .,:-.F 3' ,%�. � <br /> -- , . ;. <br /> City of Everett <br /> Enrneering Oepartment <br /> �ewer Application and Permit <br /> � , �- .; : <br /> N0. r_ !_ . 1 . . DATE �_1. '7 � <br /> � <br /> Service Address �.�n �A1�) 1�1�\�.\1� � L 1/l� Utility Account No. <br /> Biliing Address � Connection Permit Fee <br /> City, State, Zip Connection Fee <br /> Owner (Mortgagor���� S, Cn• Total Fee_ - <br /> Billing Name S Rm� <br /> Connection ey CAfv� r� <br /> Address Z.Z� �lJ TMr)�2�. Sigr,ed <br /> Customer <br /> Phone <br /> DESCRIPTION: Sewer District <br /> Lot <br /> Monthly Sewer Service <br /> Block <br /> Division or Addition Monthly Sewer Constr. <br /> Trunk <br /> Type Permit: <br /> Lateral <br /> Remarks: <br /> Abutting Lot Line <br /> N, S, E, W ft. <br /> � � — <br /> Approved By <br /> City Engineer <br /> � Issued By <br /> � Inspection By��� <br /> Datelnspected�/y/�G <br /> a <br /> SEE SKETCH ATTACHED N0. ? I_ �� 1, _I <br /> �� , ..:-(�,t)��.�i <br />