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� <br /> - I <br /> everett /..-'� ; , =� .. ..--. <br /> �-'—:��% — �.' <br /> City of Everett <br /> Engineerin� Uepartment <br /> Sev►ser Ap�alication and Permit <br /> N0. DATE <br /> Service Address _ Utility Account No. _ <br /> Billing Address Connection Permit Fee <br /> City, State, Zp Connectio� Fee _ <br /> Owner (Mortgagor) Total Fee _ <br /> Billing Name <br /> Connection By _ , <br /> Address _ Signed <br /> Customcr <br /> Phone <br /> DESCRIPTION: Sewer District <br /> Lot <br /> Block_ Monthly Sewer Service <br /> Division or Additior� Monthly Sewer Constr. <br /> Trunk <br /> Type Pcrmit: <br /> I_ateral <br /> Remarks: <br /> Abutting _ot Line <br /> N, S, E, W ft. <br /> 7 <br /> Approved By <br /> City Engineur <br /> issued By_ <br /> <- <br /> Inspectiun By�i - ��=�'"� — <br /> __ Date Inspected /�i S��� <br /> a <br /> SEE SKETCH Al'TACHED N0. '�' <br /> � <br /> i <br /> _ J <br />