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everett �/ '� � �' — "�� <br /> e . -- � e--- <br /> ,'�' % , �j <br /> � <br /> � <br /> City of Everett <br /> Engineering Uepartment <br /> Sewrer Application and Permit <br /> N0. ;` I " i; e DATE <br /> Service Address Utility Account No. _ <br /> Billing Address_ Connection Permit Fee <br /> Cit,�, State, Zip Connection Fee <br /> Owner (b1ortgagor�_ Total Fee <br /> Bilting Name <br /> Connection By <br /> Address _ _ Signed - , <br /> -, <br /> '. � � �Cus�omer - ' <br /> Phone <br /> DESCRIPTION: 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 /> y ., / Abutting Lot Line <br /> Si (�P SesJw I�o .noy.s � � �n�p� N, S, E, W ft. <br /> L i✓�1 - / Y NI /✓� c_ ..1 O¢ ) � Y't Y <br /> u,! �/d <br /> Approved By <br /> Ciry Engineer <br /> Issued By <br /> Inspection By �` �-v"" ' `""�—"' <br /> a <br /> Date Inspected � z7 ���G <br /> SEE SKETCH ATTACHED Np, � ' ' '�"�' <br />