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� � <<�.�Y� <br />0 <br />everett �, �'� ` -^�' <br />e ��� <br />City of Everett <br />Engineering Department <br />Sew�r Application and PerRnit <br />NO. � _l. � '. L <br />Service Address <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor) . <br />Billing Name <br />Connection <br />Phone <br />DESCRIPTION: <br />Lot <br />Block <br />bivision or Add <br />Type Permit: <br />DATE <br />��o S / c� /?- - <br />� � _ j 5' - � z `�— �' <br />� � �, �- � i <br />Utility Account No. <br />Connection Permit I <br />Connection Fee_ <br />Total Fee <br />Signed <br />Customer <br />Sewer District <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Trunk <br />Lateral _ <br />SEESKETCH ATTACHED <br />INSPECTION <br />Abutting Lot Line <br />N, S, E, W <br />Approved By <br />City Engincer <br />Issued <br />Inspection By�%�c�="�G�" <br />Date Inspected ��/��,�!� <br />rvo. 21522 � <br />