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eaeret't. <br />e <br />City of Everett <br />Enpineering Department <br />Sewer Application and Permit <br />,- ; �: - <br />N,' c_ . _ `- <br />Service Address_ <br />Billing Address <br />City, State, <br />Owner (Mo <br />Billing Narr <br />Connecticn <br />Phone <br />DESCRIPTION: <br />Lot <br />Block <br />Division or Addition. <br />Type Permit: <br />DATE <br />✓��jr�� <br />�_ �-_� �- <br />�- z �- <br />/ �� <br />� <br />�s <br />-�Z— <br />Utility Account P!o. ��i Z —O ( <br />Connectian Permit Fee <br />Connection Fee� �c� ,�Z-'�Z'7S <br />Total <br />Signed <br />Customer <br />SEESKETCH ATTACHED <br />Sewer District <br />Monthly Sewer Service_ 'uc�2G� <br />Monthly Sewer Constr. <br />u <br />Lateral <br />Abutting Lot L' e� � <br />N, S, ELW � � U {t. <br />Approved By <br />City Engineer <br />I SSUCCI <br />Inspection By �-��'-e� � / <br />Date Inspected�L��Z � <br />�-, � i i �.-� � , <br />NO. ; <br />