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evereil <br /> e ; _ <br /> ;, . <br /> City of Everett <br /> Enginee�ing Department I <br /> Sewzr A►pplication and P�rnzit <br /> NO. DATE ___ <br /> Service Address��� ��/ ^/ ��_,�— Utility Account No. <br /> Billing Address Connection Permit Fee <br /> City, State, Zip Connectior. Fee <br /> OwnPr (Mortgagor) Total Fee <br /> Billing Name — <br /> Connection By — <br /> Address Signed <br /> Cusiomer <br /> Phone — <br /> DESCRIPTION: Sewer District <br /> Lot ,Z0�7��'—Z Z- Monthly Sewer Service <br /> Block�$.�— �, <br /> Divi;ion or Addition�� T N S !�'0D �"' Monthly Sewer Constr. <br /> Trunk _ <br /> Type Permit: <br /> lateral--_-- ------ _- _-- <br /> Remarks: <br /> Abutting Lot Linc <br /> N� S� E- �'v— — --- ---''' <br /> � <br /> Approved By <br /> City Engineer <br /> ISSUCCI By - <br /> � <br /> a:- " <br /> Inspection By �/� �`- ``�' . .l, — — <br /> Date Inspected � <br /> �72� --- <br /> �- <br /> SEE SI:ETCH ATTACHED �� <br />