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everett 5.�(t� 9 r+..A�� <br /> City of Everett <br /> Enpineering Department <br /> 5e�nrer A►pplicati�n and Permit <br /> N0. L � �j �� � DATE <br /> Service Address Utility Account No. 7 <br /> Billing Address Connection Permit Fee <br /> City, State, Zip Connection Fee <br /> Owner (Mortgagor) Total f-ee — <br /> Billing Name <br /> Connection By <br /> Address Signed <br /> c�,s,�,�„�� <br /> Phone " <br /> DESCRIPTION: Sewer Disvict_ -- <br /> Lot_ <br /> Monthly Sewer Service <br /> Block <br /> Division or Addition _ Monthly Sewer Constr. <br /> Tru n k <br /> Type Permit: <br /> Lateral <br /> Remarks Ca�+� t,�T.F — - �°'^i <br /> Abutting Lot Line <br /> i(I4`�J. N, S, E, W ft. <br /> 1��'IUeW J' Yra. �Ya�c� <br /> I — Approved By <br /> I Ciry Engineer <br />� <br /> �SSUv'd 6y <br /> Inspection By— <br /> Datelnspected <br /> �, <br /> y SEE SKETCH ATTACHED N�� �' ' ' <br /> I <br />