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everett - . <br /> � --- �. ' <br /> City of Everett <br /> Engineering Depsrtment <br /> Sewer Application and Permit\ <br /> 33 � �1�; <br /> rvo. 2 0 91� DATE .� _- / i) -- ' <br /> Service Address_ ,'� Utility Account No. <br /> Billing Address � "' ' Connection Permit Fee. ' <br /> City,State, Zip ''�' Connection Fee ' <br /> Owner (Mortgagor) ' �� � � ' ' TotJ Fee <br /> Billing Name <br /> Connection By " <br /> Address Siyned � <br /> Customer <br /> Phone <br /> DESCRIPTION: Sewer District <br /> Lot <br /> Block_. Monthly Sewer Service <br /> Division nr Addition Monthly Sewer Constr. <br /> Type Permit: Trunk <br /> ¢ Lateral <br /> Remarks: <br /> Abutting Lot Line <br /> N, S. E, W_ ft. <br /> Approved By <br /> - , Ciry Engineer <br /> Issued By <br /> Inspection Qy <br /> o Date I nspc�cted � <br /> SEESKETCH ATTACHED �p <br />