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i <br /> � <br /> _ - � <br /> evereri � ,� -� y - � 5— , <br /> �� '�� zo z 9 3� �, � <br /> , ,' � :�! <br /> � � <br /> City of Everett � <br /> Engine:ring Department �� ' <br /> Sewer Application and Permit � <br /> , � � <br /> ,., � : , ; � ,: <br /> NO. L .L � � '� DATE / <br /> Service Address_ Utility Account No._ — i <br /> I <br /> Billing Address �� � � Cennection Permit Fee <br /> City, State, =ip Connection rae � <br /> Owner (Mortgagor� <br /> Total Fee � - " � <br /> Billing Name <br /> Connection By <br /> � <br /> Signed ' �� ' <br /> Add�eSS � 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 /> Remarkr. �, . - _ ;A6utting Lot Line <br /> , .... . '��� � �t % t N, S, E, W ft. <br /> , <br /> Approved By • <br /> Ciry Engineer <br /> Issued By <br /> Inspectian By <br /> Date I nspected <br /> B SEE SKETCH ATTACHED -, NO. n �_ 16 8 � <br />