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gv�r�tt <br />� <br />City of Everett <br />Engineerinp Department <br />�-9 lVI � ,�, � �+/ �' ' %�� l_ <br />Sewer Application and Permit <br />N0. 2 O% O O DATE' - <br />Service Address_ ` -` Utility Account No.. <br />Billing Address Cunnection Permit F <br />City, State, Zip Connection Fee_ <br />Owner (Mortgagor) Total Fee <br />Billiny Name <br />Connection Bv . <br />c <br />Plione <br />DESCRIPTION: <br />Lot <br />Block <br />Division or Addition. <br />Ty�e Permit: <br />Signed <br />c�s�o�� <br />SEESKETCH ATTACHED <br />� �,� �i,,ci <br />Sewer District <br />Monthly Sewcr Service. <br />Monthly Sewer Constr. <br />Trunk <br />Lateral <br />Abutting Lot Line <br />N, S, E, W_ <br />Approved By <br />City Enpinear <br />ISSUCd <br />Inspection By <br />)atelnspected <br />NO. %n%n�� <br />