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_ -� <br /> everett <br /> `�1 �"- , .� ; - � <br /> City of Everett <br /> Engineering Department <br /> �ewer Appliccation and Permit � <br /> N0. ,: DATE <br /> Service Address 9 �i C�) � ('`-���I/F � Utility Account No. <br /> Billing Address <br /> Conriection Permit Fee <br /> City, State, Zip <br /> Connection Fee <br /> O�vner (Mortgagor) Total Fee <br /> Billing Name <br /> Connection 3y _ , <br /> Address Signed <br /> Cusromer <br /> Phone <br /> DESCRIPTION: Sewer District <br /> Lot_f �, <br /> block Monthly Sewer Service <br /> Division or Addition� -r � �i��A� � � Monthly Sewer Constr. <br /> Type Permir � _ Trunk <br /> Laterai <br /> Remarks: <br /> `-- �'butting Lot Line <br /> -- N, S, E, W _fi. <br /> Approved By <br /> Ciry Engineer <br /> Issued By <br /> Inspection By cu.." <br /> 3 Date inspected �?� "7 <br /> � <br /> SEE SKETCH ATTAC� ' <br /> N0. <br /> � <br /> i <br /> _ �_ � J <br />