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eveRgn <br />� <br />City of Everett <br />Engineering Department <br />�_3�_��-���� <br />� <br />Sewer Application and Permit <br />NO. `z Q 8 Q 2 DATE <br />Service Address ' � � f '' � ''' �' �"' <br />Billing Address '' �' '` <br />City, State, Zip � � ' <br />Owner (Mortgagor) ' ��f 'i r% <br />Billing Name '%" <br />Connection By _ � �' ' �% ' ' <br />Address ' l ��: � ''�'` � f <br />... _ � �. � �� <br />J <br />Utility Account I�o._ <br />Connection Permit Fee_ <br />Connection Fee ' <br />Totai Fee <br />Signed <br />DESCRIPTION: Sewer District__. . — " <br />�ot Monthfy Sewer Service � <br />Block <br />Division or Addition' '� ='r`' - " ` � Monthly Sewer Constr. <br />Tru�k / i � _ <br />SEESKETCH ATTACHED <br />Abutting Lot Line <br />N, S, E, W <br />Approved By <br />City Engineer <br />Issued By <br />Inspection By /��� ���' <br />Date I nspected /�' %— �i� <br />N O. . ; , �'I :� <br />