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ev�rett � r <br />� � � � i, _. � I��.���.. . <br />,'. '� � j <br />City of Everett <br />Engineering Uepartment `�,` <br />l- <br />Sewer Ap��i��c��ion and Permit <br />fJO. ` j � �; (' DATE <br />Service Address _ Utility Account No. <br />� �! <br />Billing Address_ Connection F�rmit Fee <br />City, State, Zip Connection Fee _ <br />Owner �Mortgagor�_ Total Fee _ <br />Billing Name <br />Connection By <br />Address Signed <br />Customer <br />Phone <br />DESCRIPTION: Sewer District _ <br />Lot <br />Block Monthly Sewer Service .— <br />Civision or Addition Monthly Sewer Constr. <br />Type Permit: <br />1 <br />SEE SKETCli ATTACHED <br />Lateral <br />Abutting Lot Line <br />N, S, E, VJ. <br />Approved By_. <br />Ciry Engincer <br />Issued <br />Inspection By—_�e.���_1d' <br />Datelnspected � <br />/ <br />NO. <br />