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everet� <br />e <br />City of Everett <br />Engineering Department <br />i . ;. <br />, <br />1 � c' <br />�?��J.�,� °/;�j,. <br />� ;`?•��; � <br />, <br />Sewer Application and Permit <br />No. 2_l 0 2� DATE <br />Service Address�_/��'� �/U <br />Billing Address <br />City, Srate, Zip <br />Owner IMortqaqor) <br />Billing Nam <br />Connection <br />Phone <br />DESCRIPTION: <br />Lot <br />Block <br />Division or Addition <br />Tvpe Permit: <br />Utility Account Nc <br />Connection Permit <br />Connection Fee_ <br />Total Fee <br />Sigiied <br />Cusromcr <br />Sewer District <br />Monthly Sewer Service <br />Monthly Sewer Constr <br />Trunk <br />Lateral <br />SEESKETCH ATTACHED <br />Abutting Lot Line -- — <br />N S, E, w ft. <br />Approved By_ — <br />City Engincer <br />Issued <br />r <br />Inspectiun By— �, � /�rE/`''.�/ <br />-� ��,� • <br />Date Inspected__ <br />NO. ". jln�- <br />