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e:�erett <br />� <br />City of Everett <br />Engineering Department <br />/�n �J � _ � � <br />/_ 7 <br />�" - ` <br />� _ ,� - 7_ '1-- .S <br />Sewer Application and Permit <br />N0. � !_ ��� i-� � � DATG <br />i �' T <br />Service P.ddress <br />Billing Address <br />City, State, Zip <br />Owner IMortgagor) <br />Billing Name <br />Connection By <br />DESCRIPTION: <br />Lot <br />Block_ <br />Division or Addition <br />T,...n Pnrmii• <br />Utility Account Nc <br />Connection Permit <br />Cannectio� Fee_ <br />Total Fee <br />Signed _ <br />Cuztomer � � <br />Sewer District <br />Monthly Szwer Service <br />Monthly Sewer Constr. <br />SEE SKETCH ATTACHED <br />Abutting Lot Line <br />N, S, E, W <br />Approved By <br />City Enginecr <br />I ssu ed <br />Inspection By � - � ��`� <br />Datelnspected <br />PJO. `�.i `%fl'_ <br />