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eve; ra <br />e <br />City of Everett <br />Engineering Oepartment <br />Sewer Application and Permit <br />N0. i�.� ' I� i DATE <br />Service Address <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor).___ <br />Billing Name <br />Connection By <br />DESCRIPTION: <br />Block <br />Division or Addition <br />Tvna Parmit: <br />- � � 1` •^ - <br />,-- . . __, �-, , <br />�.� -?,f . <br />-, , <br />Utility Account No. <br />Connection Permit I <br />Connection Fee_ <br />Total Fee_ <br />Signed <br />Customer <br />Sewer District <br />Monthly Sewer Service. <br />Monthly Sewer Canstr. <br />SEESKETCH ATTACHED <br />,�..;��;��,!' .� <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />Approved BY <br />City Engineer <br />Issued <br />Ins'pection By �� """"' "� <br />Date I nspected�'a�7U <br />N0. ��_:�7 ( <br />