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i / � ' <br /> J <br /> '�^.lC.�.%� � �—� <br /> evere.tt ;�� / �_ ��- �5 5 <br /> ��- <br /> � <br /> City of Everett <br /> Engineering Department <br /> Sewer Application and Permit ;; 3 f 5� <br /> rvo. 20709 DATE _ — <br /> Service Address �•�= Utility Acco�mt No. <br /> Billing Address Connection Permit Fee <br /> City, State, ZiP Conr.ection Fee <br /> Owner (Mortgagor) Total Fee_ <br /> Billing N:+me <br /> Connection By <br /> r% � Signed <br /> Address c�:�am�� <br /> Phone <br /> DESCRIPTIOW: Sewer District — <br /> Lot Monthly Sewer Servi�e <br /> Block__ <br /> Division or Addition Monthly Sewer Constr. <br /> Trunk <br /> Type Permit: _ <br /> Lateral <br /> Remarks: Abutting Lot Line <br /> — N S E W ft. <br /> — Approved BY <br /> Ciry Engineer <br /> Issued By <br /> Inspection By� <br /> Date Inspected ���' <br /> W - <br /> SEE SKETCH ATTACHED N0. . <br />