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everett <br /> i <br /> City of Everett <br /> EnginEering Department <br /> Sewer Application and Permit <br /> NO. DATE <br /> Service Address Utility Account No. <br /> Billing Address_ —" Connection Permit Fee <br /> City, State, Zip_ Connection Fee_ <br /> Owne, (Mortgagor) Total Fee <br /> Billing Name <br /> Connection By <br /> Address Signed <br /> CUttortm <br /> I <br /> Phone <br /> DESCRIPTION: Sewer District <br /> Lot <br /> Monthly Sewer Service <br /> Block <br /> Division or Addition Monthly Sewer Constr. <br /> - — Trunk <br /> Type Permit: <br /> Lateral <br /> Remarks: _5- <br /> Abutting Lot Line <br /> N, S, E, W ft. <br /> Approved By <br /> City Engineer <br /> Issued By <br /> Inspection By ,49Z L 2 / J <br /> Date Inspected lz- /` <br /> SEE SKETCH ATTACHED No. 21197 <br /> 4 <br /> i <br />