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evl ereU ) <br />City of Everett <br />Engineering Depart-mit <br />Sewer Application and Permit <br />NO. <br />DATE <br />Service Address — <br />Billing Address. — <br />City, State, Zip <br />Owner (Mortgagor) -- <br />Billing Name <br />Connection By <br />DESCRIPTION: <br />Lot -- <br />Division or <br />Type Permit: <br />0 <br />SEE SKETCH ATTACHED <br />Utility Acccunt No.. <br />Connection Permit F <br />Connection Fee__ <br />Total Fee <br />Signed <br />Pa 5 Tom" 90 - <br />�,-/7-2-°!-5- <br />Customer <br />Sewer District <br />Monthly Sewer Service. <br />Monthly Sewer Constr. <br />Trunk — <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />Approved <br />Issued <br />City Engineer <br />Inspection By� ' <br />DwI—petted 1113176, <br />ND• 21440 <br />I <br />