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ewrett <br />r. •� <br />City of Everett <br />Enpineering Oepartment <br />�� _ � � ` ,_� `-� - �� <br />r � � <br />C�, . (,, �yl ��-� �� - , �/�� <br />� ; <br />Sewer Appiicction and Permit <br />NO. 2 O 7 O J DATE —, %�`=; — <br />Service Address . '' Utility Account No. _ <br />Billing Address ��'" - Connection Permit Fee <br />City, State, Zip ��%�'�% " Connection Fee <br />Owner (Mortgagor) � f !�'•=- -- _ Total Fee - <br />BillingName �� "-- <br />Connection By <br />Address _ Signed '%/ ' <br />' CuSiortler ' <br />Phone_ — <br />DESCRIPTION: Sewer District <br />Lot - <br />Monthly Sewer Service — <br />Block <br />Division or Addition Monthiy Sewer Constr. <br />Trunk <br />La:eral <br />SEESKETCH ATTACHED <br />Abutting Lot Line <br />N, �, E, W <br />Approved 8y ' ' ' <br />City Engineer <br />Issued B <br />Inspection <br />Datc Insoe <br />NO. � �, -, <br />i <br />