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e� �.y <br />i � <br />� ' <br />City of Everett <br />/ ^ ', [�• <br />� il�/ � v' (� �... <br />/ <br />Enpineerinp Department i ' <br />Sewer Application and Permit <br />2093� - t- <br />NO. DATE -" <br />Service Address -' '' � ' � � � <br />Billing Address - L•'��'- <br />; � r.. <br />i% —: <br />City, State, Zip ��- <r �,�� •� <br />Owner(Mortgagorl� 'i�i�S• � r �`•..":,;'•i'.� <br />Billing Name , <br />Utility Account No. _ <br />Connection Permit Fee � ��"� � ' <br />Connection Fee - <br />Total Fee <br />Connection By_ �� -'�� ' � � <br />� <br />Address Signed � ' ' <br />cu:tome. , <br />DESCRIPTION: <br />Lot <br />Block_ — <br />Division or Addition_ <br />SEE SKETCH ATTACHED <br />i��,_ i����,riori <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 />ApprovedBy-_ �• � �� ` �� � <br />Ciry Eny�neer . <br />Issued By ' <br />Inspection By <br />Date Inspected <br />No. 20934 <br />