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everett <br />� <br />City of Everett <br />Engineering Uepartment <br />, <br />� - _. <br />`� � � i, c <br />I )� ' �F'�'( �� �� � � , :'/C- <br />� ,- <br />Sewer Application and P�rmit <br />rvo. 2 0 G G 3 DATE <br />Service Address <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Name <br />Connection By <br />Address - <br />Phone <br />DESCRIPTION: , <br />Lot <br />Block <br />Division ar Addition <br />T.,..., Pormit <br />Utility Account Nc <br />Connection Permit <br />Connection Fee_ <br />Total Fee <br />Signed <br />Customer <br />Sewer Drstnct <br />Monthly Sewer Service. <br />Montnly Sewer Constr. <br />SEE SKETCH ATTACHED <br />Abutting Lot Line <br />N, �, E, W <br />Approved B <br />Issued <br />Er9inecr <br />Inspection By �`r" -- <br />Date Inspected ��r�� "- <br />NO. <br />