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everetl � <br />� <br />City of Everett <br />E�ginerr�g Ur�artment <br />: <br />Sewer ApplicatioR and Permit <br />►f�C� <br />DATE <br />Service Address Q'� � � �� <br />Billing Address <br />City, Stete, Zip_ <br />Owner (Mortgagor) <br />LZillirig Name <br />Connection By_. <br />�� 3 �_ �� �- J�-- <br />Utility Account No. <br />Connection Permit I <br />Connection Fee_ <br />Toral Fee <br />Signed <br />Phone <br />OESCRIPTION: Sewer District <br />Lot � <br />Monthly Sewer Sennice. <br />Block_��i �J <br />Division or Addition �>N /�(%!L%� ' Monthly Sewer Constr. <br />5 <br />SEE SKETCH ATTACHED <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />Approved <br />Issued <br />Ciry Engincer <br />� �--,.� <br />Inspection By �- "" �—' <br />Date Inspected��/��7,� <br />No. '?"�I' � <br />=�?�►ITZ�b 1�s1�+i� �br� atfr i..l['� i�• <br />� <br />