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everctt1 <br />� I <br />City of Everett <br />Engineering Oepartmont <br />, = , <br />�' � ; . <br />�.Z��' <br />' , ,� � <br />i. � �'i� <br />Sewe�� A�p�`c�tion cand Permit <br />PJO. �._ . _ DATE <br />Service Address '� Utility Account No. <br />Billing Address Connection Permit I <br />City, State, 2ip �" Connection Fee_ <br />Owner (Mortgagor) Total Fce <br />gilling Name � <br />Connection By - <br />Phone <br />DESCRIPTION: <br />Lot _ <br />Block___ <br />Division or Add <br />Type Permit: <br />Remarks: <br />Siyned <br />Sc�ver Disti ict__ <br />Monthly Sevver Service <br />Monthly Sewer Constr. <br />� <br />S[[ SKF_TCH AITACHED <br />Lateral <br />Abuttin9 Lot Line <br />N, S, E, W_--_ <br />Approved <br />Issued <br />CItV Engmcrr <br />ft. <br />—, <br />lospection By � ` — <br />Date 1 nspected �''�� Y/ 7 y <br />"T'_�— <br />N0. <br />