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everett <br />`�- <br />City of Everett <br />Engineering Depertment <br />Sewer Application +�nd Permit <br />NO. 2 �.. 2 � J_ DATE <br />Service Address — <br />Billing Address <br />City, State, Zip <br />Owner �Mortgagor) — <br />Billing Name <br />�,onnection Bv <br />DESCRIPTION: <br />Lot _ <br />Block <br />Division or Addition. <br />■ <br />. - e � � �.= i_% <br />�i -3�- ���-s <br />z— ys =7� <br />,�� �� <br />Utility Account No.. <br />Connection Permit F <br />Connection Fee_ <br />Total Fee <br />Signed <br />Customer <br />Sewer District <br />Monthly Sewer Service. <br />Monthly Sewer Constr. <br />SEE SKETCH ATTACHED <br />i?;�,i';-.�'�(I; i?, <br />Latera <br />Abutting Lot Line <br />N, S, E, W <br />Approved By _ <br />CitV Engineer <br />Issued <br />Inspection By <br />Date Inspected <br />n -• - <br />rvo. 2 :�_ r_ !- ' <br />