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everett <br />� <br />City ot Everett <br />Engineering Department <br />Sewer Application and Permit <br />N0. : ; ' i 2� � � DATE <br />ServiceAddress - ��Q�I �NL,¢ — <br />_. <br />Billing Address <br />City, State, Zip <br />Owner (��ort�agor) <br />Billing Name — <br />Connection By <br />Address <br />Utility Account No. <br />Connection Permit Fee <br />Connection Fee <br />Total Fee <br />Signed <br />Customer <br />DESCRIPTION: Sewer District__ <br />Lot�L ��C; 1 `� <br />Monthly Sewer Service <br />Block �% <br />Divisian or Addition�1� �% '�� ��- Monthly Sewer Constr. <br />Lateral <br />Abutting Lat Line <br />N, S, E, W <br />Approved By <br />Ciry Engincer <br />ISSUB� <br />Inspection <br />Datelnspe <br />� <br />SEE SKETCH ATTACHED ��� <br />