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V1 , 7, <br /> City of Everett <br /> Engineering Department <br /> Sewer Application and Permit <br /> 33735 <br /> NO. 210 -156 DATE - - — - - <br /> Service Address_" __ _ Utility Account No._ <br /> Billing Address Connection Permit Fee _ <br /> City, State, Zip r/'� �� Connection Fee— <br /> Owner (Mortgagor)— c' Total Fee_ <br /> Billing Name <br /> Connection ey <br /> Address - Signed <br /> Custonwr <br /> Phone <br /> DESCRIPTION: Sewer District <br /> Lot c[ , <br /> Block Monthly Sewer Service <br /> Division or Addition Monthly Sewer Cos <br /> Type Permit: Trunk <br /> Lateral <br /> Remarks: - A i ;" c <br /> — — Abutting. Lot Line <br /> S, E, IN 353 __ft. <br /> Approved By <br /> City Engineer <br /> Issued By. _ <br /> Inspection By <br /> o Date Inspected <br /> SEE SKETCH ATTACHED NO. 20756 <br /> i <br /> I <br />