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> i <br />ever'efl I ( ' z `7 � � <br />.e � � � �(,, �, ��� � <br />(;'., ; �'" � 2 �J�u%% <br />City of Everett <br />Engineering Department <br />Sewer Application and Permit <br />rvo. 20711 DATE � � <br />r ;,, - �, ;� , <br />Service Address <br />� <br />City, State, Zip ' ' � ` <br />-� -. i..; i `. <br />Owner (Mortgagor) <br />Billing Na <br />Connection By <br />! � ,�,_ <br />Address <br />-�� ; c� � i: :. <br />_ �i <br />Phone ' , , <br />Utility Account No. <br />Connection Permit I <br />Connection Fee_ <br />Total Fee " <br />Signed <br />cu:,orrrer <br />DESCRIPTION: Sewer District <br />Lot �- �:� �' � Monthly Sewer Service <br />Block - ; ,f' <br />Division or Addition %� •`�� Monthly Sewer Constr. <br />.f <br />T�...n Parmif' <br />SEE SKETCH ATTAI:HFD <br />� ���,i����;�i , <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />Approved By <br />Ciry Engineer ' <br />ISSUCd <br />Inspection By <br />Datelnspected �� <br />N O. '� [� I .I. �. <br />