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everen <br /> e � � _ � Z � � � . <br /> � <br /> City of Everett ^ {� <br /> Eogineering Department ,�J� '��2 r <br /> I � <br /> Sewer Application and Permit <br /> rv o. 215 �i :i <br /> DATE <br /> . r,,.- <br /> Service Address <br /> Utility Account No. <br /> Billing Address <br /> Connection Permit Fee <br /> City, State, Zip <br /> Connection Fee <br /> Owner (Mortgagor) <br /> Total Fee <br /> Billing Name <br /> Connection By <br /> Address <br /> Signed <br /> Phone C�stomer <br /> DESCRIPTION: <br /> Lot�_ Sewer District <br /> Block !�—'Z"� `-'�- � <br /> Monthly Sewer Service <br /> Division or Addition <br /> Monthly Sewer Conszr. <br /> Type Permit: Trunk <br /> Remarks: Lateral <br /> Abutting Lot Line <br /> N, S, E, W _ft. <br /> Approved By , <br /> City Enpineer <br /> Issued By <br /> i <br /> Inspection By �� � � ���R�. <br /> ° Date Inspc�cted ����/7G <br /> SEESKETCH ATTACHED <br /> N O. '•� _� j . <br /> IhL;f'�i',��,,: � <br /> �. . <br /> • <br />