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everett - <br />� - ���i - - <br />� _ I - � i� <br />/ � - �,' <br />City of Everett <br />Engineering Oepartmen[ <br />Sevver Applicafion an�i Permit <br />NO. 1 r �, u DATE � <br />Service Address Utility Account No. _ <br />Billing Address Connection Permit Fee <br />City, State, Zip Connection Fee <br />Owner (Mortgagorl— Total Fee <br />Bi�iing Name <br />Connection Bv. _ <br />DESCRIPTION: <br />Lot <br />81ock <br />Division or Addrtion <br />Type Permit: <br />Remarks: 4-'� <br />SL=[ 51<ETCH ATTACH[D <br />Siyned <br />m�m�m <br />��:� ��;:�� <br />Sewer District <br />Monthly Sewer Service __ _ _ _ <br />Monthly Sewer Constr. <br />Trunk_ <br />Lateral <br />Abutting Lot �ine <br />f�J, S. E. !'J _ h. <br />Aporoved Dy------ --- ------- <br />r,�:, i_.,����,,.,.. - <br />ISSUB(i Eiv___ _ _ _ _- ._ _ ____ <br />InspectionE3y�--/�� ______ <br />Date Ir�spected a- /S _ _ _ <br />N0. <br />