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everefl <br />e <br />City of Everett <br />Engiaeerinp Department <br />Sewer Application and Permit <br />�, : � <br />N0. � 1 � H DATE <br />Service Address <br />Billing Address <br />City, State, <br />Owner (Mortgagor) <br />Billing Name <br />Connection <br />Utility Account Na. <br />Connection Permit I <br />Connection Fee_ <br />Total Fee____ <br />/ =�i,� � "�"`>'�s� <br />�.___. <br />i _ z. o -�Z�.--� <br />�� <br />a <br />Signed " <br />Customer <br />DESCRIPTION: Sewer District <br />Lot <br />Block Monthly Sewer Service <br />Division or Addition '' _Monthly Sewer Constr. <br />SEE SKETCH ATTACHED <br />I:1�;1'f��:l liifd <br />Lateral <br />Abutting Lot Line <br />N, S, E, W. <br />Approved <br />Ciry Engineer <br />I ssued <br />�� <br />Inspec:ion By_�, L �zu.-�— <br />Date Inspected_ ����7 C <br />N0. ! � .ii� <br />