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'evergft 1 �� �ll`%�9s./� _ _ <br /> .� �/1� <br /> � � tvf J <br /> �� ��� <br /> City of Everett <br /> Engineering Oepartment � <br /> Sewer Application and Permit <br /> ;: 3 `� `'0 <br /> N0. 2 O H S � DATE __ <br /> Service Address � � ' % ' ^ Utility Account No. ' 'i' �'�` ' 'J <br /> Biiling Address ' ' ' - _ Connection Permit Fee �' ��J� ' <br /> City, State, Zip ' �'i'� ' Connection Fee ' — <br /> Owner (Mortgagor) :'�'� / '� . �. l • '; ';•, , Total Fee � <br /> Billing Name ;�%.' '= <br /> r - ,-. . <br /> Connection By�i:"�i"_. %%�i J . ' a'%:�,:: �% �,' � " <br /> Address '" ' /�s �nii'� � Signed <br /> cu:,omer <br /> Phone � � _ ,=r_��.�-�� � <br /> DESCRIPTION: Sewer Di�trict <br /> Lot_ � So <br /> Block Monthly Sewer Service <br /> Division or Addition Monthly Sewer Constr. <br /> '%';= �: -'� -- �� '— <br /> Type Permit: Trunk <br /> ;� ,�:�� ,j.,� , Lateral <br /> , <br /> Remarks: <br /> Abutting Lot Line <br /> � 'r �� r/�� .. r�r - �I N, S, E, W ft. <br /> � <br /> ��� Approved By �—. '��"��, ' _'�`�, <br /> __ Gry Enginecr <br /> � i <br /> ,'1 , <br /> Issued By " .' � : <br /> Inspection By ��� -�� � � ��4 / <br /> ; i <br /> Date Inspected �:� .�� Z.� �:'7�.� <br /> 0 <br /> SEE SKETCH ATTACHED N0. �) � � � �� <br /> � <br />