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everett <br />� <br />City of Everett <br />Engineering Department <br />Sew�r A,pplication and F�ermit <br />�, <br />N0. C.'- -� ,_ , DATE <br />Service Address _; ? <br />Billing Address <br />City, State, Zip --- <br />Owner (Mortgagor) <br />Biiling Name — <br />Connection By <br />DESCRIPTION: <br />Lot <br />Block <br />Division or Addition <br />Type Permit: <br />Remarks: <br />�.f . / ' <br />,.. , <br />r�/ i. -- <br />�-1 �' r, l` .r L%G' � .li �r.: —/.� _ <br />Utility Account No. <br />Connection Permit I <br />Connection Fee_ <br />Total Fee <br />.f; � :+, i� .. . _ <br />Signed <br />Cusinmar <br />Sewer District_ __ <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Abutting Lot Line <br />N, S, E, W <br />Approved By -- <br />City Engineer <br />Issued B <br />Inspection <br />Datelnsae <br />o--- - <br />SEE SKETCH ATTACHED N0. ,- } ` � <br />