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everett� � • _ <br /> .� �. '�. <br /> �� � <br /> � °. � 6�.'... 7--Z� - ., . <br /> City of Everett �. � �,, � ` <br /> Engineering Department � <br /> Sewer Application and Permit :, -� --�`. •�`�� : <br /> N0. � 1. J -L �;� DATE <br /> Service Address Utility Account No. � <br /> Billing Address Corr�ec:ion Permit Fee <br /> City, State, Zip _ Connection Fee — <br /> Owner (Mortgaqor) Total Fee i <br /> Billing Name <br /> Connection By <br /> Address Signed — <br /> Customer <br /> Phone <br /> DESCRIPTION: Sewer District <br /> Lot <br /> Monthly Sewer Service <br /> Block <br /> Division or Addition Monthly Sewer Constr. <br /> Trunk <br /> Type Permit: <br /> Lateral <br /> Remarks: <br /> Abutting Lot Line <br /> N, S, E, W ft. <br /> � <br /> Approved By__ <br /> Ciry Enp:neer <br /> Issued By <br /> Inspection By� ��' 7� i <br /> — ; <br /> Date Inspected — <br /> _ , <br /> A <br /> SEE SKETCH ATTACHED N�• �� � , �_ '• <br />