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everett ,/�0 3 ��� <br /> e ,J _ , U � .._ <br /> City of Everett <br /> Engineerinp Department <br /> Sewer Applic�tion cnd Permit <br /> NO. r : �� : ;� DATE <br /> Service Address _ Utility Account No. <br /> Billing Address Connection Permit Fee <br /> City,State, Zip Connection Fee <br /> Owner (Mortgagor) Total Fee <br /> Billing Name <br /> Connection By <br /> Address Signed <br /> Customer <br /> Phone <br /> DESCRIPTIUN: Sewer Disirict <br /> �ot� <br /> lock �_-� � Monthly Sewer Servica <br /> �Division or A d tion�y .= _ �� Monthly Sewer Constr. <br /> ���r.�-�- � r <br /> Type Permit: Trunk <br /> Lateral <br /> Remarks: <br /> Abutting Lot Line <br /> N, S, E, W ft. <br /> /1�-� ����-cZr.L � <br /> Approved By <br /> City Enpineer <br /> ISSl1Cd B�/ <br /> Inspection By �� /��-��*-<--� <br /> a <br /> Date I nspected ��� 3�17 <br /> SEE SKETCH ATTP.CHED NO. '.% 1 `, ' � <br />