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everett <br />�+ <br />City of Everett <br />Engineering �epartment <br />� � � 3 J Z r� � <br />Sev�✓er Applieation and P�rrviit <br />NQ _ DATE <br />Service Address_ <br />Billing Address __ <br />City, State, Zip __ <br />Owner (Mortgagor) Ti JZ� _ <br />Billinq Name_ <br />Connection By <br />Address <br />Fhone <br />DESCRIPTIOiV: <br />Lot ' � /i`;<� �.c'c <br />Block <br />Division or Addition <br />Type Permit: <br />Utility Account No. <br />Connection Permit Fee <br />Connection Fee <br />Total Fee <br />Signed _ <br />Customer <br />SE�SKETCH ATTACHED <br />Sewer District _ <br />Monthly Sewer Service_ <br />Monthly Sewer Constr. <br />Trunk <br />Lateral <br />Abutting Lot Line <br />N, S, E, W. <br />Approved <br />c��� <br />Issued <br />InspectionBy ��� ���-� %^c�.c,—° <br />Date l nspected ��.��7 � _ <br />N0. <br />