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ev re[t 11 ' iJ `� c n ,/� .;'u <br />� -'_ � - � � „=� <br />City of Everett <br />Enqineering Oepartment <br />Sewer Application and Permit <br />N0. ��Q��7 DATE _ <br />Service Address_ <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Name <br />Connection By <br />DESCRIPTION: <br />Lot <br />Division or Addition_ <br />T....,, o,.....;.• <br />Utility Acc�unt Nc <br />Connection Permit <br />Connection Fee_ <br />Total Fee <br />Signed <br />Customer ' <br />SEE SKETCF7 ATTACHED <br />Sewer District <br />Monthly Sewer Service. <br />Monthly Sewer Constr. <br />Abutting Lot Line <br />�d, S, E, W <br />Approved E3y <br />City Engincer <br />Issued <br />) >'-G�.�'�'t.....� <br />Inspection By ,t� _ — <br />Date Inspected� /�'� <br />N0. ''���, �- <br />