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evdrefi <br />e <br />City of Everett <br />Enginee�nq Dep�rtment <br />�e <br />...._�__ -�� <br />„,�� � r!'= �.�'','�,l> <br />�' . <br />,_ .....�������- <br />�� <br />Sewer 4pplication and Permit <br />no. 213 3 3 DATE <br />Service Address <br />Billing Address <br />City, State, Zip <br />pwner (Mortgagor) <br />Billing Name <br />Connection By <br />Address <br />DESCRIPTION: <br />Lot <br />I Block <br />IDivision or Addition <br />� <br />T...... D..�m7f• <br />Utility Account No. <br />Connection Permit I <br />Connection Fee_ <br />Total Fee <br />Signed <br />Sewer District -� <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />SEESKETCH ATTACHED <br />INtiPE�;I fON <br />Abutting Lot Line <br />N,S,E,W <br />Approved By <br />Ciry EnBineer <br />I ssued <br />Inspection By <br />Date Inspected ' � <br />rvo. 21338 <br />