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everett <br />e <br />City of Everett <br />Engineering Department <br />Sewer Appli�ati��n and Permit <br />N0. C_ i_ I�� l <br />- - DATE <br />Service Address <br />Biliing Address <br />City, State, 2ip _ _ <br />Owner (Mortgagor) <br />Billing Name <br />Connection By <br />Address <br />�_. <br />t;_�_z�_� <br />,_ � <br />i> <br />�.. <br />Utility Account Na._ <br />Connection Permit F� <br />Connection Fee <br />Total Fee <br />Signed <br />Customer <br />DESCRIPTION: ScwerDistrict' � <br />Lot <br />Block Monthly Sewer Service <br />Division or Addition_ -�, �' Monthly Sewer Constr. <br />Type Permit: Trunk <br />SEESKETCH ATTACHED <br />Abutting Lot Line <br />N, S, E, W <br />Approved By � <br />City Engineer <br />Issued Bv <br />Inspection By_� i <br />)ate Inspected —" <br />N O. _, . <br />