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everett 1 � , �J .i _ � <br /> �� ,� ;�� <br /> e �_�., � � � � , .,,. <br /> City of Everett <br /> Engineering Department <br /> Sewer Application and Permit <br /> No. 20984 DATE _. - –�- . <br /> ServiceAddress � ` ` '' ' ' f�'�''=' ' Utility .4ccountNo. . ` <br /> � �%,_/� <br /> Billing Address � � Connection Permit Fee �' _. <br /> Ci:y,State, Zip � ' i' r � Connection Fee — <br /> Owner (Mortgagor) / r "�' ��'i:%�-' Total Fee ' <br /> , <br /> Billing Name_," -'�%%%� <br /> , , _ - � . . -- <br /> Connection By ' ` � � <br /> . <br /> ,.1,� <br /> Signed ��i � : ,: , , ' <br /> Addf055 Customer <br /> Phone <br /> DESCRIPTION: Sewcr District <br /> Lot_._._— Monthly Sewer Service <br /> Block <br /> Division or Addition � � Monthly Sewer Constr. <br /> Trunk <br /> Type Permit: �;- � _ _ <br /> Lateral <br /> Remarks: _ _ Abutting Lot Line <br /> �, S. E, W ft. <br /> — — Approved By= ' - <br /> City Engmeer � <br /> � <br /> Issued By <br /> . <br /> Inspectian By ' -- <br /> Date Inspected <br /> a <br /> SEE SKETCH ATTACkED N0. `.� (l �1 �. -i <br />