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�everett <br /> e ��a ���� O <br /> � i-� � U1 � � <br /> City of Everett � <br /> Engineerinp Uepartment i � <br /> Sewer Application and Permit <br /> NO. � .� F .1. r� DATE N� K�:, s �- �.- 7- 7-� <br /> Service Address Utility Acco::nt No. <br /> Billing Address Connection Permit Fee <br /> City, State, Zip Connection Fee <br /> Owner (Mortgagor) Total Fe� <br /> Billing Name <br /> Connection By_ <br /> Address Signed <br /> Cusmmer <br /> Phone_ _ <br /> DESCRIPTION: Sewer District <br /> lot_ ,c <br /> Block Monthly Sewer Service <br /> Divisiun or Addition Monthly Sewer Constr. <br /> Type Permit: Trunk ' <br /> Lateral <br /> Remarks: <br /> Abutting Lot Line <br /> N, S, E, W ft. <br /> —�� <br /> Approved By <br /> Ciry Engineer <br /> Iss:ied By <br /> Inspection By ������Et—� <br /> e <br /> Date Inspected�� �7� <br /> SEE SKETCH ATTACHED No. 2151 5 <br />