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everett <br />� <br />City of Everett <br />Engineering Oepartmeot <br />Sewer Application und Permit <br />N0. ,� 1_ _ i <br />Service Address_ <br />Billing Address_ <br />City, State, Zip_ <br />Owner lMortgagor) <br />Billing Name_ <br />Connection By_ <br />DESCRIPTION: <br />Lot <br />Block <br />Division or Addition <br />Tvna Permit: <br />DATE <br />��5� ��_� <br />�- —3 0 — �_�,--� <br />Utility Account Nc <br />Cennection Permit <br />Connection Fee_ <br />Total Fee <br />Signed — <br />Customer <br />Sewer Distnct — <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />SEESKETCH ATTACHED <br />If�!S"C� l�!iif� <br />Abutting Lot Line <br />N, S, E, W <br />Approved By <br />City EnBineer <br />I ssu ed <br />C. Brossard <br />Inspection By <br />Qate I nspected S��S �� �' <br />� No. 2137"� <br />