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everett � � •� C� - �- <br />e �� � - > > �._ �:� r 7 � _. ;., ,� <br />L; , � - ;: , �,� - <br />I � <br />City of Everett <br />Engineering Depanment <br />Sewer Application and Permit <br />rvo. 20642 DATE <br />Service Address ,`� ur <br />Billing Address. <br />City, State, Zip <br />� <br />.,,i;;ti? <br />Utility Account Nu. <br />Connectian Permit f <br />Connection Fee_ <br />Jwner (Mortgagor) Total F <br />� <br />Connection By � ' <br />DESCRIPTION: <br />Lot <br />Block <br />Division or Addition <br />Tvpe Permit: <br />Signed <br />Customer <br />Sewer <br />SEESKETCH ATTACHED <br />if:ti;��r�.i��� �. <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Abutting Lot Line <br />N, S, E, W <br />Approved By <br />City 6�ginecr <br />Issued <br />Inspection By �r�-��`xu^� <br />Date I nspected�/� y <br />NO. � �) h �1 n <br />