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�. __ _ . -� <br />� <br />, l _ <br /> everett <br /> . . <br /> � ��� :. . �— � <br /> � / �! _ I l ✓ <br /> City of Everett <br /> Engine:ring Uepartment <br /> Sewrer Application anci �drrni# j <br /> N0. DATE _ <br /> Service Address Utility Account No. _ <br /> Billing Address Connection Permit Fee <br /> City, State, Zip Connaction Fee <br /> Owner (Mortgagor) Total Fee <br /> Billing Name _ <br /> Connection By <br /> Ad�iress Signed_ <br /> Customer <br /> Phone_ � <br /> DESCRIPTION: Sewer Di;trict <br /> Lot M�nthly Sewer Service <br /> Block � <br /> Division or Addition Monthly Sewer Constr. <br /> 'i <br /> Trunk <br /> Type Permit: <br /> Lateral <br /> Remarks: <br /> Abutting Lot Line <br /> N, S, E, W ft. <br /> �i ' <br /> Approved By <br /> Ciry Engineer <br /> Issued By <br /> — � 7 <br /> Inspection By �� • ��K� <br /> _�Date Inspected ��/`��7 �P <br /> e <br /> SEE SKETCH ATTACHED N0. 2 _;_ =} (. `,_; <br /> L2 <br /> C� <br /> i <br /> i <br />