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. � <br />> <br /> - �f. �� <br /> everetf �_, ���Ap�.6'� <br /> � <br /> City of Everett <br /> Engineering Oepartment <br /> Sew�r Applicati�r� and Permat <br /> N0. DATE _ -- <br /> UtilitV Account No. — <br />' Service Address_ - <br /> r Connection Permit Fee <br /> Billing Address <br />, Connection Fee -- — <br /> City, State, Zip <br /> Total Fee__ — <br /> pwner �Mortgagor) — <br /> Billing Name <br /> Connection By ------"— <br /> Signed ---- <br />� /ad(�f05S ----' Cuvro;mr <br />' Phone <br /> i� Sewer District -- <br /> DESCRIPTION: <br /> i Lot Monthly Sewer Servi�e_ --------- <br />� Block_ � <br /> Division or Addition Monthly Sewer Constr. <br /> Trunk — <br /> Type Permit: Lateral _ — <br /> Remarks: Abutting Lot Line ft. <br /> N, S, E, W— ----- <br /> �,��,� -� <br /> � <br /> qpproved BY City Engineer I <br /> — I�sued By <br /> /��i <br /> r�4�/ ��'��'� _ i <br /> Inspection By ' <br /> i <br /> _ Date I nspected a �� �� --- <br /> 3 N 0. � � �� � , <br /> SEE SKETCH ATl'ACHED <br />�_ _ _ __ --- . —' <br />