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evere.tL � , -- � <br /> � � Z� — �C <br /> City of Everett <br /> Engineering Oepartment j <br /> Sewer Application and Permit <br /> 20871 33 !)?t <br /> N0. DATE ' - <br /> Service Address : - � Utility Account No. <br /> Billing Address � %%' = Connection Permit Fee <br /> City, State, 2ip % ' r� r ' � Connection Fee - <br /> Owr.er (Mortgagor) -�%•v/ + /'-- Total Fee_ <br /> Billing Name ' '� � <br /> -, ;� , - �� -- <br /> Connection By � � y' � �< < � <br /> Address Signed <br /> Customer <br /> Phone <br /> DESCRIPTlON: Sewer District <br /> Lot ' <br /> Block_ -' Monthly Sewer Service <br /> Division or Addition '' _Monthly Sewer Constr. <br /> � Tru n k <br /> Type Permit: — <br /> Lateral <br /> Remarks: <br /> Abutting Lat Line <br /> N, S, E, W it. <br /> � � / �� , <br /> -- — - Approved BY--. � � . . <br /> CitV Engineer <br /> ISSUE� BV <br /> Inspection 8y G��`1 ��9 <br /> / � <br /> Datelnspected_ '/S - 5 <br /> 0 <br /> SEE SKETCH ATTACHED NO. `-' � I �; / ] <br />