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� <br /> everett > <br /> � / ' <br /> City of Everett <br /> Engiueering Deaartmant <br /> Sewe� A►pplication and Permit � �,� � n <br /> N0. `Z O ( �G � DATE <br /> Service Address `' � Utility Account No. <br /> Biiling Address <br /> Connection Permit Fee <br /> r Connection Fee <br /> City, State, Zip_ <br /> Owner (Mortgagor) _ Totai Fee <br /> Billing Name <br /> Connection By <br /> S�gned <br /> Address Cu�mmcr <br /> Phone <br />' DESCRIPTION: Sewer District <br /> j Lot Monthly Sewer Service <br /> Block <br /> Division or Addition ___ Nlonthly Sewer Constr. <br /> Trunk <br /> Type Permit: <br /> Lateral <br /> Remarks: Abutting Lot Line <br /> N S �, W-- ft. <br /> Approved By <br /> City E��9�neer <br /> _ ISSUE� By <br /> Inspection By � `�-`} <br /> Date lnspected � �� � — <br /> � <br /> SEE SKETCH ATTACHED N�' ` � <br /> ti�� <br /> I <br />