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everett � � <br />� <br />City of Everett <br />Engineering Oepartment <br />Sewer Application and Permit <br />No. 2 0 i 7 3 DATE <br />Service Address � - <br />Billing Address _ <br />City, State, Zip <br />Owner (Mortgagor) ` <br />Billing Name <br />Connection By __ _ <br />DESCRIPTION: <br />Lot <br />Block <br />Division or Addition <br />Tvnn Parmit <br />Utility Account No._ <br />Connection Permit Fi <br />Connection Fee_ <br />Total Fee — <br />Signed <br />c�,�om�, — <br />SEE SKETCH ATTACHED <br />Sewer District <br />Mo��thly Sewer Service_ <br />Monthly Sewer Constr. <br />Trunk <br />�ateral <br />Abutting Lot �ine <br />N, S, E, W - - <br />Approved By_ <br />C�.ry Enqmeer - <br />Issued <br />7 <br />Inspection By �'"% ___ <br />Date Inspected /v�7� <br />/ ! <br />N0. <br />