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everett <br /> � -�` <br /> �i� �'l � 1 � � n <br /> i <br /> City of Everett <br /> Engineering Department <br /> Sewer Application and Permit <br /> N0. �- � f� ',-_� DATE <br /> Service Address Utility Account No. <br /> Billing Address ' Connection Permit Fee <br /> City, State, Zip Cunnection Fee � <br /> Owner �Mortgagor) Total Fee <br /> 6illing Name <br /> Connection By <br /> Address Signed _ <br /> c�s,o�,.�, <br /> Phone <br /> DESCRIi'TION: Sewer District <br /> Lot Mcnthly Sewer Service <br /> Block . <br /> Division or Addition Monthly5ewerConstr. <br /> Trunk <br /> Type Permit: <br /> Lateral <br /> Remarks: <br /> _ � Abutting Lot Line <br /> N� S� E, W ft. <br /> � � - <br /> Approved By_ <br /> City EnBlnecr <br /> � <br /> Issued By — <br /> Inspection By—_ — <br /> Datelnspected ' <br /> 3 <br /> SEESKETCH ATTACHED N0. <br />