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-evere� <br />e <br />City of Everett <br />Engineering Department <br />S�wer Application and Permit <br />NO. _ _ : .; 1 DATE <br />Service Address <br />Billing Address <br />City, State, Zip <br />Owner (Mortyagor) <br />Billing Name <br />Connection By <br />Phone <br />DESCRIPTION: <br />Lot <br />Block <br />Division or Addi <br />Type Permit: <br />l�OSYG�"� <br />�''--t�-Z q �5— <br />t� - ..� ._ �; - <br />f••?�'°L% ��� <br />Utiiity Acco�i�t No._ <br />Connection Permit Fee_ <br />Connection Fee <br />Total Fee _ <br />Signed ' c'' ' . <br />Customer <br />SEESKETCH ATTACHED <br />� ,�:;r�ecri� ,v <br />Sewer District_ <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />Approved By <br />City Enpineer <br />Issued <br />nspection By � <br />latelnspected � '%� <br />No. 21,01 <br />