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I <br /> l <br /> everett <br /> e ��- . � <br /> �_ � . <br /> �� L C� - �� 'i - � <br /> City of Everett � /-, � ,��-� <br /> Engineering Department <br /> Sevver Applitation and Permit <br /> ,� ; , ,, DATE i <br /> N0. r_ 1 _� _. <br /> ,' <br /> Service Address? �,�—��A� Utility Account No. <br /> Eilling Address Connection Permit Fee <br /> City, State, Zip " ' Connection Fee <br /> Owner (Mortyagor) Total Fee <br /> Billing Name __ <br /> Connection By .-- <br /> Address Signed ' <br /> Cusmmer <br /> Phone <br /> DESCRIPTION: Sewer District <br /> Lot_'.Z��$— Monthly Sewer Service <br /> Block� <br /> Division or Addition Monthly Sewer Constr. <br /> Trunk <br /> Type Permit: <br /> Lateral <br /> Remarks: Abutting Lot Line <br /> � N, S, E, W ft. <br /> Approved By <br /> � . cfty Eoefoeor <br /> Issued By <br /> Inspection By <br /> Date Inspected <br /> o SEE SKETCH ATTACHED No� 216 3 2 <br />