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everett <br />� <br />City of Everett <br />Engineering Department <br />?;1-��d, �'. '-., .. <br />; , - _. �s . �. . ,;,= <br />5ewer Application an�! Permit <br />NO. �' = �� �. b DATE <br />Service Address_ <br />Billing Address <br />City, State, Zip_ _ <br />Owner (Mortgagor) <br />Billing Name <br />Connection Bv <br />DESCRIPTION: <br />Lot <br />Block <br />Division or Addition. <br />Utility Account Nc <br />Connection Permit <br />Connection Fee_ <br />Total Fee <br />Signed <br />Custort ' <br />SEE SKETCH ATTACHED <br />� , . <br />Sewer District " <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Latera <br />Abutting Lot Line <br />N, S, E, W. <br />Approved By <br />Ciry Engincer <br />ISSIICCI <br />Inspection By� ' <br />(� <br />Datelnspected �3/7(, <br />/ <br />No. 2:'.. � 1_. � <br />y7? y� y a ."�` <br />