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everetl � <br /> � l . , �J L L � „ <br /> , . � y;: �' , <br /> (,, � / �;� ,;� .�- <br /> City of Everett <br /> Engineering Department <br /> Sev�aer Application and Permit <br /> � �: � � �, <br /> NO. ( � (� j �l DATE <br /> Service Address - Utility Account No. - <br /> Billing Address '�f- Connection Permit Fee <br /> City, S.ate, Zip " � - Connection F2e <br /> Owner (Mortgagor)_ ' � Total Fee_ <br /> Billing Name <br /> Connection By — <br /> Address Signed _ <br /> Custamer <br /> Phone <br /> DESCRIPTION: Sewer District -- <br /> Lot <br /> Monthly Sewer S�rvice <br /> Block <br /> Division or Addition � A1onthly Sewer Constr. <br /> Trunk — <br /> Type Permit• <br /> Lateral <br /> Remarks: <br /> Abutting Lot Line <br /> N, S, E, W----- ft. <br /> Approved By <br /> City Engine=r <br /> Issued By <br /> Inspection By� <br /> _ Date Inspected���� <br /> a <br /> S.ESKETCH ATTACHED N0. <br /> i _ � � <br />