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�_<=. _ <br />ei•erett <br />� <br />��tY of Everett <br />Enpineerinp pepart��iani <br />Sewer ApAlication and Permit <br />N0 <br />DATE <br />�_ <br />Service qddress <br />Billing qddress_ <br />City, State, Zip__ <br />Owner �— <br />(Mortgagor) <br />Billing Name <br />Connection Pv <br />DESCRlPTION: <br />Lot <br />---_ <br />Block�_ <br />Division or Addition. <br />TYpe Permit: <br />Utility qccount No. <br />Connectian Permit F <br />Connection Fee__ <br />Total Fee <br />Signed <br />Cuslomer '--�� <br />SEE SKETCH ATTACHED <br />Sewer District <br />Monthl�� Sewer Service <br />-----. _ <br />Monthly Sewer Constr. <br />Tru�k <br />Lateral <br />Abutting L.ot Line <br />N, S, E, W. <br />�PProved By <br />GtY Enpineer �— <br />sued B <br />cPection By. � '_'� ,'. <br />:c Inspected -- <br />---, -------.—_--- <br />N0. , .� r. <br />