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,:verett — . _ , • , <br /> � %t�i�j�� :R 1=-, - . <br /> City of Everett <br /> Engincering Department ' �'� <br /> Se�nrer �►pplication and Permit <br /> N� '� " ( '; '�j DATE <br /> !_ i � �S <br /> Service Address Utility Acrount No._ — <br /> Billing Address— Connection Permit Fee <br /> City, State, Zip — <br /> " Connection Fee <br /> Owner IMortgagor� _— Tot�+l Fec____-- ---- <br /> Billing Name <br /> Conr.ectic� By — <br /> Address . Si�necl _ --- -- — — - — <br /> Customer <br /> Ph0110_ — <br /> DESCRIPTION: SewerDistrict _ ------ - - - <br /> Lot MonthlySewerService__ _—__ - -- -- — <br /> Block . <br /> Division or Addition Manthly Sewer Canstr. <br /> Trunk_____ _ __--- <br /> Type Permit: <br /> Lateral - <br /> Remarks: � 4�� G%✓E �E �� Abutting Lot Line <br /> _1 D 1� �6 �< /. <br /> Gi� U, S, E. W ------it. <br /> �� '� " S `� <br /> _��i�rr nu„�";a ,,�usr d,v�c s�i•�o .a,� c s <br /> l✓�` S - ieoH �/ G�c APProved [3Y._—. -- -- <br /> N � �S � .fT L/N � Ci�y Engir.ecr <br /> _J�d� <br /> _ � �SSUI'(j �V—_—._ __. —___ _ __—_ . .—. _ . <br /> i <br /> — Inspect�on Uy�-s�-=1L���-"`%--- <br /> Date Inspected � 7 — <br /> F:E SKETCH ATTl�CHED N0. <br />