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everetf <br />� <br />City of Everett <br />Engineering Department <br />Sewer p►pplica�ion cand Perrr�it <br />, .� ,,�.,;� <br />N0. , _ . ' C7�°�� DATE <br />�-' � � <br />Service Address <br />Billing Address <br />City, State, 2ip <br />Owner (Mortgagor) <br />Billing Name <br />Co�mection Bv_ <br />Phone <br />DESCRIPTIGN: <br />Lot �_ <br />��7��-�-��'�J <br />,f� —� � �'� .5 <br />+�, t» � 4 a wk�j; 'ji": .r <br />i= -'."' <br />� � a J�s< <br />. . .� ,_���, <br />�. <br />Utility Account No. <br />Connection Permit I <br />Connection Fee_ <br />Total Fee <br />Signad <br />Cusmmer <br />Sewer <br />Block ?� Monthly Sewer Service. <br />Divis�o�� or Addition_��eyg,����r ��,�,�Q-� Monthly Sewer Constr. <br />� ��, <br />Type Permit: <br />� <br />SEESKETCH ATTACHED <br />IflSPECTION <br />Tru <br />Abutting Lot Line <br />N, S, E, W <br />Appraved By <br />City Engineer <br />ISSU����CI <br />Inspection By /� ` �u^-� <br />Date Inspected �� S��i <br />N O. �_ .� J`i ii <br />