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everett <br />� <br />City of Everett <br />Engineering Department <br />�.- _/ 1�% — ._. ,�.,j �._ - - . <br />i <br />C.J <br />7 � .--� '- _o "� <br />, _ �. <br />� ,a- - <br />� <br />Sewer Application and Permit <br />NO. �,( n�• <br />�J�:J <br />Service Address__ <br />8illino Address <br />City, State, Zip <br />Ownr.r (Mortgagor�_ <br />Billing Name <br />Connection By_— <br />Address_ <br />Phone <br />DESCRIPTION: <br />Lot <br />Block <br />Division or Addition— <br />Tvnn Permit: <br />DATE <br />Utility Account No.. <br />Connection Permit F <br />Connection Fee_ <br />Total Fee <br />Sign <br />c����o�.,�� <br />Sewer Uistrict <br />Monthly Sewer Service. <br />Monthly Sewer Constr. <br />SF[ SK[TCH ATTi1CH5D <br />Abuttiny �ot Line <br />N, S, E, W <br />Approved By._' � ' <br />City Engineer <br />Issued Bv -- <br />�' ��� "' <br />» <br />Inspection By— — — <br />Datelnspected z- iz �S _—_ <br />N0. <br />