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evqr^tt <br /> • � Q' - I <br /> City of Everett <br /> Engineering Departmen? <br /> Sewer �4pplication a�nd Permai� 3 .j � � �, <br /> N0. `' ' i ;; DATE <br /> C_�) ;: _ <br /> Service Address Utility Account No. <br /> BilGng Address Connection Permit Fee <br /> City, State, Zip Connection Fee <br /> Owner (Mortgagor) Total Fee <br /> Billing Name <br /> Connection By <br /> Signed — <br /> /�C�(�fESS - Curinmcr <br /> Phore <br /> DESCRIPTION: Sevver District <br /> Lot Monthly Sewer Service <br /> Block r��f•�ir �' <br /> Division or Addition Monthly Sewer Constr. �� �,�,;i„_ !. <br /> o � <br /> `/j�J;:. <br /> Trunk --�-� � ' — <br /> Type Permit: _ <br /> Lateral ti!�� �_ <br /> Remarks: � i4'r"V '1! Abutting Lot Line <br /> � �° N S E W ft. <br /> ,� 'i t� Pi( i� — � <br /> S � /i� l S���rl <br /> Approved By_. <br /> City tn�mecr <br /> - Issued By <br /> inspection By�.���'r ��'�=� - — <br /> Gate I nspected ��- �- j'S --- <br /> � SEE SI<ETCH ATTACHED N�' I <br />