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everatt <br />� <br />City of Everett <br />Engineering Department <br />� � � (� `� ���� � �' <br />(�,-��_ <br />�,,,( � �, f_ <br />Sewer Application �nd P�rrv�it <br />NO. <br />Service <br />LOEl% DATE <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor{_ <br />Billing iVame <br />Connection Bv—__ <br />DESCRIPTION: <br />Lot _ <br />Block <br />Divi,ion or Addition <br />Type Permit: <br />Utility Account Nc <br />Connection Permit <br />Connection <br />To±al Fee <br />Signed . <br />Cusmmer <br />SEE SKETCH ATTACHED <br />Sewer District � � <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />-��--Trunk D % � v <br />Lateral l� /� <br />Abutting Lot Line <br />N, S, E, W, <br />Approved By . ; <br />citv Engineer � <br />Issued <br />Inspection By �l� <br />�ate Inspected `{��,�'���1 <br />NO. ,,�,, <br />