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r <br />everrtt <br />� <br />City of Everett <br />Engineering Department <br />Sewer Application and Permit <br />N0. r� 1_- �=° � DATE <br />3�io G�'.�jil�/J <br />Service Address <br />Billing Address " — <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Name <br />Connection By <br />DESCRIPTION: <br />Lot <br />Block <br />Division or Addi;ion <br />Type Permit: <br />Utility Acco�nt Nc <br />Connection Permit <br />Connection Fee__ <br />Total Fee <br />Signed <br />SEE SKETCH ATTACHED <br />Ifts.���� <br />Sewer District <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Trunk <br />Lateral _ <br />Abutting Lot Line <br />N, S, [, W <br />Approved By <br />Ciry Engineer <br />Issued <br />Inspection By <br />Date Inspected ^ <br />NO. ' , �n� <br />'�'- `'= <br />