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everett <br />e <br />City of Everett <br />Enginee�ng Department <br />Sewer Application and Permit <br />n,� � n,' <br />N0. � 1 `� � � DATE <br />$ervice Address � � � Q ` ��� ��`' %L <br />Billing Address_ <br />City, State, Zip_ <br />Utility Account Na. <br />Connection Permit <br />Connection <br />Owner (Mortgagor) Total <br />Billing Name <br />Connection 8y <br />Signed <br />Customer <br />DESCRIPTION: Sewer District <br />Lot /4� Monthly Sewer Service. <br />Block�— <br />Division or Addition Cr�•— ••� �iLl Monthly Sewer Constr. <br />SEESKETCH ATTACHED <br />ir.icncOTIC1iJ <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />Approved By <br />Cip' En9ineer <br />I SSU @C� <br />Inspection By ' _ _ <br />Date Inspected __ --- <br />No. ?1621 <br />