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everett` <br />� <br />City of Everett <br />Engineering Department <br />Sewer Application and Permit <br />No. 2.13 6 G DATE <br />Service Address <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor►_ <br />Billing Name <br />Connection Bv <br />DESCRIPTION: <br />Lot <br />Block <br />Division or Addition <br />Tvoe Permit: <br />- --- <br />.- ` f ..-�,�--- : <br />�.i- .t _ ,. <br />j.r'�::.' � � , <br />�- ?�-�-'I-S <br />Utility Account No. <br />Connection Permit I <br />Connection Fee_ <br />Total Fee <br />e <br />Signed � <br />Cusmmer <br />SEE SKETCH ATTACHED <br />�P.';PECili�i' <br />Sewer District <br />Monthly Sewer Service. <br />Monthly Sewer Constr. <br />Abutting Lot Line <br />N, S, E, W <br />Approved By = <br />City Enpineer <br />Issued <br />Inspection <br />Date Inspe� <br />NO. ?"t ^� r <br />- .-; �. , <br />