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s <br />everelt <br />� <br />City of Everett <br />1 / , -� � 7 �� � <br />�� ,-U�` � �.� <br />� <br />Engineenng Department <br />Sev�er Appiieation and Permit <br />rvo. � �'3 i' i� <br />Service Address_ <br />Billirg Address— <br />City, State, Zip_ <br />Gwner (Mortgagor) <br />Billing Name_ <br />Connectior By_ <br />Phone <br />DESCRIPTION: <br />Lot <br />Block <br />Division or Addition <br />r....,, oe�...�r• <br />DATE �-- <br />9�� ��` `'`� <br />Utility Account No. <br />Connection Pcrmit I <br />Connection Fee_ <br />Total Fee_ <br />Signed _---- <br />c��,io�,�� <br />,�.3�:��� <br />Sewer Disirict <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Trunk _ <br />�ateral <br />:,EE SKETCH ATTACHED <br />Abutting Lat Line <br />N S, F, VJ__ <br />Approved E3y__ <br />� (;ii�� Enginccr <br />�SSUC(I Ej�� ----- <br />__.Jr-N='�=� ��>Y���r!!� <br />Inspection By � � � <br />Date I nspected z z -- <br />N0. '���c- <br />