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evefett <br />� <br />City of Everett <br />En�ineering Department <br />Sewer Application and Permit�� <br />N0. - <br />Service Address <br />Billing Addre:;s__ <br />City, State, Zip <br />Owner (Mortgagor)_ <br />Billing Name <br />Connection By <br />DESCRIPTION: <br />Lot <br />Block <br />Civision or Adclition <br />Type Permit: <br />DATE <br />Remarks: .g'S ���� �yliCfi <br />i <br />/Nl't t�/'F�S //o�s,E iYo �i?/� <br />/�CSU, <br />. , � <br />J� ) / . .. .. . <br />SEESKETCH ATTACHED <br />Utility Account No. <br />Connection Permit I <br />Connection Fee_ <br />Total Fee <br />Sign <br />Sewer District__— <br />i�lonthly Sewer Service. <br />Monthly Sewer Constr. <br />Abutting Lot Line <br />. N, S, E, W <br />Approved By <br />City Engineer <br />I ssu ed <br />� i _�C.��-�� <br />Inspection By �� �" �--� / -- <br />Date I nspected_ ��5 � f � <br />NO. <br />