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everett <br />e <br />City of Everett <br />Engineering Department <br />Sewer Applicction and Permit <br />NQ � �. �' , , DATE <br />Service Address <br />Billing Address <br />City, S.ate, Zip <br />Owner (Mortgagor) <br />Billing Name <br />Connection Bv_ __ _ <br />DESCRIPTION: <br />Lot <br />Block <br />Division or Addition <br />Type Permit: <br />Utility Accaunt Nc <br />Connection Permit <br />Conner.tion Fee_ <br />Total Fee <br />SEESKETCH ATTACHED <br />ir.SP: ,., I��i�; <br />��.-z.� --� <br />����� <br />�� /`,� <br />Sewer District ' <br />Monthiy Sewer Service <br />Monthly Sewer Constr. <br />Abutting Lot Line <br />N, S, E, W <br />Approved By <br />l:ity Engincer <br />I ssu ed <br />Inspection By — <br />Date �nspected — �7 �� <br />N0. ��_,`'i;� <br />