Laserfiche WebLink
evereH' <br />� <br />City of Everett <br />Engineerinp Depertment <br />' � �T''_ :�-�"!�' <br />.,_i1; "��. <br />~r <br />� . �-iy.. .'� _.�..�,� .� <br />Sewer Application and Permit <br />rvo. 2'!_ !' 19 <br />Service Address <br />Eiilling Address_ <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Name <br />Connection Bv— <br />Phone <br />DESCRIPTION: <br />Lot <br />Block <br />Division or Addition <br />DATE <br />Utility Accaunt No. <br />Connection Permit I <br />Connection Fee_ <br />Total Fee <br />Signed <br />Customer <br />SEESKETCH ATTACHED <br />i� ;;,�,���I 10i7 <br />Sewer District <br />Monthly Sewer Service_ <br />Monihly Sewer Constr. <br />Lateral <br />Abutting Lot Line <br />N, S, E, W ft. <br />Approved By <br />City Engineer <br />I ssu ed <br />Inspection By � , � <br />Datelnspected Z o <br />N0. �.L/'t�� <br />