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everelt <br />� <br />City of Everett <br />Engineering Department <br />Sewer Applieation a�nd P��mit <br />N0. <br />DATE <br />Service Address �'�/ % S , �� � <br />3illiny Address�� ii� S � n /� �� <br />'��_ <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Name_ <br />Connection Bv <br />DESCRIPTION: <br />Lot <br />Block <br />Division or Addition <br />Type Permit: <br />0 <br />Utility Account No. <br />Connection Permit F <br />Connection Fee_ <br />Total Fee <br />Sign�.d <br />—cu:temer ..—"_" —_ <br />Sewer District_ <br />Monthly Sewer Service _ <br />Monthly S .Wei Constr. <br />l�unk_ _ <br />Lateral <br />Abutting Lot Line <br />N, �, E, W. <br />it. <br />Approved By <br />Ciry Enpineer —� <br />Issued <br />I nspection <br />)atelnsp� <br />SE� St<ETCH ATTACHED �� <br />