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everetl <br /> City of Everett m <br /> Engineering Department <br /> Sewer Application and Permit 3 4 0;, t <br /> ND. 20936 DATE --- <br /> , t <br /> Service Address j 1 --5.�- / — Utility Account No. — <br /> Billing Address -- - <br /> Connection Permit Fee_ <br /> City,State, Zip -- <br /> Connection Fee <br /> Owner (Mortgagor) — Total Fee <br /> Billing Name_ <br /> Connec-ion By— <br /> Address Signed cu.tomer <br /> Phone — <br /> DESCRIPTION: Sewer District — <br /> Lot — Monthly Sewer Service <br /> Block <br /> Division or Addition Monthly Sewer Constr. <br /> Trunk <br /> Type Permit: —_� <br /> Lateral <br /> Remarks: y ^ o �. Fi✓� As "FSTET. ✓. i Abutting Lot Line <br /> N S E W ft. <br /> Approved By_ <br /> Cily Engineer <br /> Issued By <br /> Inspection By__--,Date I nspected _ //--2�'i-- <br /> No 20936 <br /> SEa SKETCH ATTACHED <br /> I <br />