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everett <br />e <br />City of Everett <br />Engineering Department <br />Sewer Application and Permit <br />NO. �.� �,:,•-� <br />_ L . L . � <br />Service Address <br />Billing Address <br />City, St�te, Zip <br />Owner (Mortga <br />Billing Name_ <br />Connection Bv_ <br />DESCRIPTION: <br />Lot <br />Block <br />Division or Addition <br />Permit: <br />DATE <br />�- "/� <br />����`.� <br />i�-�-z� s <br />Z_�G•-�� <br />/�,<� �� <br />Utility Account No. <br />Connection Permit f <br />Connection Fee <br />Total Fee <br />Signed <br />Customer <br />SEE SKETCH ATTACHED <br />Sewer District <br />Monthly Sewer Service. <br />Monthly Sewer Constr. <br />Trunk <br />Lateial <br />Abi�'ting Lot Line �'7� <br />N, S, E, W� ft. <br />Approved 'dy_ <br />City Engineer <br />Issued <br />Inspection By � <br />Date Inspected / — �' — <br />NC. ;� �I � � 3 <br />