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everett - /!`' g `�'��, - <br /> � � � c�l . :_ ,�_ � <br /> City of Everett <br /> Engineering Department <br /> Sewer Application and Permit <br /> N0. � 1 r_1 .; �? DATE <br /> Service Address 1�� Utility Account Na. <br /> Billing Address Connection Permit Fee <br /> City, State, Zip Connection Fee <br /> Owner (Mortgagor) Total Fee <br /> Billing Name <br /> Connection By <br /> Signed <br /> AdC�f85S Cusromer <br /> Phone <br /> DESCRIPTION: Sewer District <br /> Lot Monthly Sewer Service <br /> Block <br /> Division or Addition . Monthly Sewer Constr. <br /> Trunk <br /> Type Permit: <br /> — Lateral <br /> Remarks: Abutting Lot Line <br /> N, S, E, W ft. <br /> � <br /> Approved By <br /> City Engincer <br /> Issued By <br /> Inspection Ry�{'"u`"'� <br /> i � <br /> Date I nspected���" <br /> e SEE SKETCH ATTACHED No. 21434 <br />