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ev�s►ed <br /> Je -�➢J{�� �;,y,� ��� <br /> . �, �� , 7-zy_S , <br /> City ot Everett <br /> Engineering Department <br /> Sewer Application and Permit <br /> No. 2C821 - 33 �4 '; <br /> DATE ' � ' - <br /> Service Address �_ � _ Utility Account No. <br /> Billing Address Connection Permit Fee ^ -- �- - <br /> City, State, Zip '- _ -r-.- Connection Fee -- <br /> Owner (Mortgagor) � � r :-.�. Total Fee - ' <br /> Billing IVame <br /> Connection By - � � - � ' -� <br /> Address Signed <br /> Customer <br /> Phone <br /> DESCRIPTION: Se�ver District <br /> Lot [. <br /> Block Monthly Sewer Service <br /> Divisiun or Additi� n Monihly Sewer Constr. <br /> Type Permir. _ Trunk <br /> ,:� r1 r <br /> Lateral <br /> Remarks: <br /> Abutting Lot Line <br /> N, S, E, W ft. <br /> / <br /> ✓+ ;n,ir--� <br /> � _ <br /> � <br /> Approved By ' i " <br /> City Engineer <br /> U"' �5 -- . <br /> � �o Issued By <br /> , <br /> L ��� ' G� � <br /> � Inspection By �'1� �-Ss�u�'� �7 .QM <br /> v <br /> Date l nspected_ �� �w ��/ <br /> � , _ � SEE SKE'iCH ATTACHED NO. <br />