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eYe��i� <br />�'. <br />City of Everett <br />Engineering Uepartment <br />�ewer Applieation and Perrr�it <br />N0. � _�_ 3 �-I � DAl"E <br />Service Address <br />Billing Address _ <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Nama <br />Connection By � <br />Address ' <br />DESCRIPTION: <br />Lot <br />Block <br />Div�sion or Addition <br />Tvoe Permit: <br />Utility Account Nc <br />Connection Permit <br />__ Connection Fee_ <br />� �Total Fee <br />,, ,�• :;; .. . ... <br />_ Signed=',,. -;,t,1 i•r . . _ � <br />� ' " Cusromer � - � <br />SEE SKETCH ATTACHED <br />��'.���n«'�'I�'�`�- <br />Sewer District <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Abutting Lot Line <br />N, S, E, W. <br />Approved <br />Issued <br />Inspection By <br />Datelnspected <br />Engineer <br />No. 21344 <br />�1 <br />