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everett <br />� <br />City of Everetc <br />Engineering Oepartment <br />�� �v ✓ �="_'� <br />i� ." � <br />:Z_ I-.z:''`/�- <br />Se�wer Ap�SlRcation and Permit <br />N0. <:1. �r 7 � DATE �`� - - �'/, <br />i � <br />ServiceAddre«s �� <br />Billing Address <br />City, State, Zip - �:� <br />Owner (Mortgagor) <br />j Billing Name <br />Connection By <br />Utiiity Account �c <br />Connection Permit <br />Connection Fee_ <br />Total Fee <br />;' <br />Signed <br />, Customer <br />Phone <br />DESCRIPTION: Sewer District <br />Lot. <br />B���k_ Monthly Sewer Service <br />Division or Addition . Monthly Sewer Constr. <br />Trunk <br />Lateral _,4_ <br />SEE SKETCH ATTACHED <br />If 1`.'��'�-CTIOfd <br />Abutting Lot Line <br />N, S, E, W 1t. <br />11p{�rovod By <br />CityEnpineer �� . <br />Issued <br />Inspection By � <br />Datelnspected <br />�'�' No. 21 �4 7 7 <br />