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1 <br /> \ <br /> evPrett <br /> y � � ,-- � , L, ., , <br /> � n, _ --�- � ��f���__ � <br /> V � , 1 , �-�� <br /> City oF Everett <br /> Engineering Department ,�� <br /> r, <br /> w <br /> S�wer Applicc,tion and Permit � <br /> . , <br /> N0. 21 U � �r DATE � <br /> Service Address Utility Accou�it No. <br /> i <br /> Billing Address Connection Pennit Fee � <br /> City, State, Zip _ Connection Fee <br /> Owner (Mortgagor) Total Fee � <br /> Eilling Name ' <br /> Connection By <br /> Address Signed <br /> Customer <br /> Phone <br /> DESCRIPTION: Sewer District <br /> Lot <br /> Block_ Monthly Sewer Service <br /> Division or Addition Monthly Sewer Constr. <br /> � <br /> — Trunk <br /> Type Permit: <br /> Lateral � <br /> i <br /> Remarks: �;�N,`i,`TE�� — y� �yS ,Fr ie.� <br /> Abutting Lot Line <br /> _ N, S, E, W ft. <br /> � � <br /> � <br /> / a8 is� <br /> � Approved By_. _ _ <br /> Ciry Engineer <br /> Issued By <br /> Inspection By <br /> Date Inspected <br /> a <br /> SEE SKETCH ATTACHED N0. `> � rl `; ii <br /> � <br />