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everett <br />� <br />City oi Everett <br />Enpineerinp Department <br />�o� y--`=-� ^„ • . <br />�j _ $— Z 9 ;S —'. <br />Sewer Application and Permit <br />NO. r_ ) .` i DATE _ <br />Service Address Utility Account No. <br />Billing Pddress <br />City, State, 2ip_ <br />Owner (Mortgagor) ' <br />Billing Name <br />Connection Bv <br />Connection Permit <br />Connection <br />a <br />Total <br />Signed � c_! " t � <br />cu+tomer <br />DESCRIPTIOR: Sewer District <br />lot <br />Block Monthly Se,ver Service. <br />Division or Addition %�� � Monthly Sewer Constr. <br />Type Permit: <br />SEESKETCH ATTACHED <br />Trunk <br />Lateral <br />Abutting Lot Line <br />N,S,E,W <br />Approved By <br />Ci�y Enpinem <br />I SSUCd <br />Inspection By�� '� ��-� <br />Date Inspected %'.��3�71 <br />rvo. ? 1 ? � ,. <br />