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everen � � <br /> e _ _ - ,. <br /> - ,_ �_ ,.; <br /> City of Everett <br /> Fngineering Oepartment I <br /> �ew��F:►r i4pplication and Permit <br /> N��. _ DATE <br /> Service Address_._ Utility Accourt No. <br /> Billing Address_ _ Connection Pe-mit Fee <br /> City, State, Zip Connection Fe= <br /> Jwner (Mortgagor) Toial Fee_ <br /> Billin� Name <br /> Conn�ction By_ <br /> Address Signed " <br /> Customer <br /> Phone <br /> DESCRIPTION: Sewer District <br /> Lot <br /> Block Monthly Sewer Service <br /> Division or Addition Monthly Sewer Constr. <br /> Type Permit: Trunk <br /> Lateral <br /> Remarks: <br /> � � Abutting Lot Line <br /> . � N� S� E� W-- #t. <br /> Approved By <br /> Ciry Engineer <br /> Issued By <br /> ' Inspection By ���Gl�--u <br /> a <br /> Date Inspected_� 7 � <br /> SEE SKETCH ATTACHED N0. � 1 (�{ (i �) <br /> ir. „ i � <br /> � <br /> �-,. <br />