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e'vereft <br />e <br />City of Everett <br />Engineering Uepertment <br />Sewer Application and Permit <br />N0. G.���`� DATE - <br />Service Address - <br />Billing Address = <br />City, State, Zip � <br />Owner (Mortgagor) - � < ; <br />Billing Name <br />Connection By b in i� c...� S,� t <br />�_� <br />�� �> > � � <br />Utility Account No. <br />Connection Permit Fee � <br />Connection Fee = ` <br />Total Fee— _. ...-..::a: _i� , • - � <br />Signed_ <br />Customer <br />Phone <br />DESCRIPTION: Sewer District <br />Lot r. <br />Block Monthly Sewer Service <br />pivision or Addition --� Monthly Sewer Constr. <br />r___ „____._. Trunk <br />Lateral <br />SEESKETCH ATTACHED <br />�r,�r-eCl i,;t; <br />Abutting Lot Line <br />N, S, E, W. <br />Approved <br />Enpineer <br />Issued <br />Inspection By <br />Datelnspected <br />rvo. ?_ i 2 4 �J <br />