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everett � <br />�I` — <br />�� ( i / '_��� � - <br />/ p,, <br />__. ��_� _/� / '%i- <br />City of Evere:t <br />Engineering Oepartment <br />Sewer Appl��at'•an and Permit <br />rvo. 20633 oA,t <br />. Utility Account No._ <br />Service Address — <br />Connection Permit Fee <br />Billing Address��-- <br />Connection Fee <br />City, State, Zip_ <br />Total Fee._ <br />Owner (Mortgagor) <br />Billing Nsme <br />Connection BY <br />Signed <br />Address -'�— <br />DESCRIPTION: <br />L.ot �— <br />Block_—_—� <br />Division or Addition <br />Type Permir. — <br />Remarks: <br />Sewer Distnct <br />Monthly Sewer Service. <br />M�onthly Sewer Constr. <br />Trunk <br />Lateral_ <br />Abutting Lot Line <br />N, S, E, W- <br />SEE SKETCH ATTAVncv <br />>pproved f3Y c��v e„U��,�-•� ------- <br />Issued By�---- <br />Inspection By-----� <br />Date Inspected�--- — <br />NO. ;�r <br />