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CVC7nt� <br />� <br />City of Everett <br />Engine�:ing Oepartment <br />�{ / <br />� <br />�" (�_?� _`7 l���l�a �, <br />Sewer Application and Permit <br />NO. ;' � f ;-' (1, DATE <br />Service Ad.iress <br />B�Iling Address _ <br />City, State, Zip _ <br />Owner (fvl �rtgagor) _ <br />Billing Name � <br />Connection Bv_ — <br />0 <br />Phone �._ <br />DESCRIPTION: <br />Lot <br />Block <br />Division or Addition <br />Type Permit: <br />Utility Account No. <br />Connection Permit Fee <br />� ' /�— 7 <br />Connection Fee <br />Total Fee <br />Signed <br />Cusiomei <br />� <br />SEE SKETCH raTTACHED <br />Sewer Distric[ <br />Manthly Sewer Service <br />Monthly Sewer Constr. <br />Trunk <br />Lateral �IGt/� <br />Abutting Lot Line <br />N, 5, E, W_ <br />Approved By <br />c��� <br />Issued Bv <br />� <br />Inspection By— �`� <br />)ate Inspec:ted � �2� 7 <br />/ N0. <br />