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everen <br />e �; <br />City of Everett <br />� <br />/ ���� - �� �- '�. � �j/��<"<�/" <br />J _ . `- ,. <br />Engmeenng Departmenl �, <br />Sewer Applicatic�n and Permit� <br />N0. 2O �'. 1 7 DATE � <br />Service Address r <br />Billing Address_ •- �� <br />City, State, Zip.L '% f ' �_ � / `� <br />Owner (MortgagorlT.��' ,-� <br />Billing Name <br />� <br />Connect�on By_: __ _ __ <br />Address . i r _ - i ' iri% �� � <br />� ' ,,.i <br />Utility Account No.. ' -' <br />Connection Pcrmit Fee__ <br />Conner�i�n Fee <br />Total Fee � <br />Signed � ' I <br />Cuslomer <br />DESCRIPTION: Sewer District <br />Lot <br />Block Monthly Sewer Service <br />Division or Addition� 1�:,' -'� ��%r Monthly Sewer Constr. <br />n <br />SEE SKETCH ATl'ACHED <br />Lateral <br />Abutting Lot Lina <br />N, S, E, W <br />Approved B <br />Ctly Engineer <br />ISSUCf� <br />Inspection By�_�. � _- � _i.�,� ,� �".' <br />)atelnspected_ _______ <br />N0. <br />