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i <br /> evereri � _ - <br /> � / � <br /> � � <br /> � — �_� � - �� � —`-/�� ��� 3� � 7S� _t.J` <br /> City of Everett <br /> Engineering Uepartment <br /> 5ewer //-�pp@ieatio� and Permit <br /> � � � v �a <br /> N0. LO7 � O DATE , _ <br /> Service Ad�jress 3�f 9-- _ Utility Account No. <br /> Billing Address ' Connection Permit Fee <br /> City, State, Zip -����:",' Connection Fee <br /> Uwner (Mortga3or) Total Fee <br /> Billing Name_.. I <br /> , _ <br /> Connection By_.i_ ',-, ; � <br /> Address � , ': _ Signed <br /> Customer <br /> Phone ,' <br /> DESCRIPTION: Scwer District <br /> Lot <br /> Block � � Monthly Sewer ;ervice <br /> Division or Addition " -/'�� Monthly Sewer Constr. <br /> Type Permit: - i Trunk_ <br /> Late�al <br /> Remarks: �p /N5� s Q-� <br /> Abutting Lot Line <br /> �2— O -7 N, S, E, W <br /> ft. <br /> Approved By - <br /> Ciry Engincer <br /> Issued By <br /> Inspection By <br /> 3 Date Inspected <br /> SEE SKETCH ATTACHED N0. ',} �; �] C? (1 <br />