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eyerett <br />e�- <br />City of Everett <br />Engineering Depaitment <br />Sewer �4pplicutoon �anc� P�rmit <br />NO. �: .' � .�� �`i �7ATE <br />C .�—� <br />Service Address <br />Billing Address <br />Utility Account <br />Connectio�i Permit <br />City, State, Zip Connection <br />Owier (A1ortgagor)_ _ Total Fee_ <br />BiCing Name__ <br />Connection By_ <br />Address <br />Phone <br />DESCRIPTION: <br />Lot <br />Block <br />Division or Addition <br />Type Permit: <br />Signed <br />cuswmcr <br />SEESKETCH ATTACHED <br />� <br />�ev✓er Dist <br />Monihly Sewer Service <br />Monthly Sewer Constr. <br />Trunk <br />Abutting Lot Line <br />N, S, E, W ft. <br />Aoproved By <br />Ciry Engincer <br />Issued <br />r\ <br />Inspection By \ 'G--� <br />Date Inspectc � _ <br />N0. `�' "1 '� C3 i:, <br />