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everett <br />� r I r �,,j/ �.'' � � • t1 � <br />t �jj �j � ` a ,i.,;; ; '�. <br />City of Everett � , <br />Engineering Uepartment <br />5ewer Application and Permit <br />N0. <br />Service <br />� �J p'L ( DATE <br />Billing Address <br />Utility Accaunt PJo. <br />Connection Permit <br />City, State, Zip Connection Fee <br />Owner (Mortgagor) Total Fee_ <br />� <br />Connection By <br />Address <br />DESCRIPTION: <br />Lot <br />Block _ <br />Division or Addition <br />Type Permit: <br />Signed <br />Customer <br />SEE SKETCH ATTACHED <br />Sewer District <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Trunk _ <br />Lateral <br />Abutting Lot Line <br />N, S, E, N/ ft. <br />Approved By _ <br />City Enpinccr <br />I ssued <br />Inspection By <br />Datelnspected <br />No. 2Gi 2 r' <br />0 <br />. <br />J <br />