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everett <br /> � �� - � � � � <br /> ; (� �, � �/�/� <br /> City of Everett � � � �/)�/�. <br /> Engineering Oepartment <br /> Sewer Application and Permit <br /> 34n�*�� <br /> No. 2 �j� 5 � DATE <br /> Service Address Utility Account No. <br /> Billing Address Connection Permit Fee <br /> City, State, Zip Connection Fee_ <br /> Owner (Mortgagor) Total Fee <br /> Billing Name <br /> Connection By <br /> Address Signed <br /> c�:�om�� <br /> Phone <br /> DFSCRIPTION: Sewer District <br /> Lot <br /> Block Monthly Sewer Service <br /> Division or Addition Monthly Sewer Constr. <br /> Type Permit: Trunk <br /> Lateral -',' <br /> Remarks <br /> Abutting Lot Line ; <br /> / N, S, E, W ft. <br /> �` r , — <br /> /1S O�',� S.re-Tt . <br /> ��� � s� � <br /> Approved By_. <br /> City Engineei <br /> Issued 8y <br /> Inspection By_ � ��\a� <br /> n Date Inspected y `—Z 1— 7.5� <br /> SEE SI(ETCH ATTACHED NO. <br />