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_ 1 <br /> 0 <br /> � <br /> e.verett <br /> U <br /> City of Everett <br /> Engineering Department <br /> Sewrer �4pplieation and Perr��t <br /> r�in, ' i DATE -- <br /> _ � � ��/2 / /Or•i fJ�-� ;c= <br /> Service Address �� � S Utility Account No.__ <br /> Billing Address_�r_T �' Connection Permit Fee - <br /> City, State, Zip _ Connection Fee <br /> �IO/ll C S <br /> Owner (Mortgagor) —�---_' � �'�^/'» Total Fee <br /> Billing Name <br /> Connection By <br /> Address Siyred <br /> c��.,�R:,,, <br /> Phone <br /> DESCRIPTION: Sev:ar District_ <br /> Lot <br /> Block Monthly Sewer Service__ _ <br /> Division or Addition Monthly Sewer Const�. <br /> Trunk <br /> Type PermiL <br /> Lateral <br /> Remarks: <br /> Abutting Lot Line <br /> N, S, E, W_ _ft. <br /> , ; <br /> Approved Ry__. <br /> - . --- <br /> � Ciry En9ina�r <br /> ISSUBd Ciy <br /> Inspectiur� nv_. i . ____ <br /> �Date I nspected_ S2 '1 � -�� _ _____ _ <br /> � jSEE SI<["iCf1 ,aTTACHED i�10. <br /> J <br />