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;� � <br />everett � _ : .�-- � " . <br />-3C'' -�J�-` -�� , !-.�� _j ` �?�- 1�' <br />� � <br />City uf Everett <br />Engineering Department <br />Sewer i4ppiicatoon cncs Permit <br />No. 207G ,� DATE — <br />2 `i � - — � <br />Service Addr - - ' -` <br />gilling Address <br />City, State, Zip <br />Owner (Mortgagor�, ' <br />Billing Name <br />Connection By " <br />Address <br />� <br />DESCRIPTION: <br />Lot <br />Block <br />Division or Addition <br />Tvnn Parmit• <br />Utility Account No._ <br />Connection Permit Fee <br />Connection Fee <br />Total Fee <br />Signed <br />a — <br />SEESKETCH ATTACHED <br />Customer . <br />Sewer District <br />Monthly Sewer Service <br />Monthly Sewer Censtr. <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />Approved By <br />City Engmec� <br />Issued <br />Inspection By � ✓� <br />Date Inspected / %7 `i <br />N 0. '� -' <br />ft. <br />