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everett <br />� <br />City of Everett <br />Engineering Department <br />Sewer Applicction and Permit <br />N0. �' �. �"' � DATE <br />Service Address� �o i � i /�Q���J,c �� <br />Billing Address_ <br />City, State, Zip_ <br />Owner (Mortgagor)_ <br />Billing Name <br />Connection By_ <br />Phone <br />Utility Account No. <br />Connection Permit I <br />Connection Fee_ <br />Total Fee <br />Signed <br />f.us�omer <br />DESCRIPTION: Sewer District <br />Lot � ('��:1 I_ �"J�j�-n�y,Gr <br />Block_��_ Monthly Sewer Service. <br />Division or Addition ��/ E��' � _ Monthly Sewer Constr. <br />SEE SKETCH ATTACHED <br />Lateral <br />Abutting Lot Line <br />N, S, E, W'. <br />Approved Ey <br />ciry Enpineer <br />Issued <br />Inspection <br />Date <br />N0. �� i (,, ' <br />