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everen <br />e <br />City of Everett <br />Engineering Department <br />Sewer Applicc�tion and Permit <br />No. 2i :�:,% <br />Service Address_ <br />Billing Address_ <br />City, State, Zip_ <br />Owner (Mortgagor) <br />Billing Name_ <br />Connection By_ <br />DESCRIPTI ON: <br />Lot <br />Block <br />Division or Addition <br />Type Permit: <br />DATE <br />, -- P -- ,. <br />Utility Account No. <br />Connection Permit F <br />Connection Fee_ <br />Tot�l Fee <br />Signed <br />Cmtomer <br />SEESKETCH ATTACHED <br />Sewer District <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />Appraved By <br />Ciry Enpineet <br />I ssued <br />Inspertion By �����'^.c-ti.-� _ <br />�ate Inspected 19 <br />rvo. ;= 1 r ;; <br />