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� <br />everett <br />e, <br />City of Everett <br />Enginaerinp Uepartment <br />Sewer Application and Pe�mit <br />NO. �� i:�, �; l} DATE <br />� <br />� � �; `% �;.� / � <br />Service Address � �-'�"' _ <br />'' . _ . , , . ,. . -r - <br />Billing Address <br />City, State, Zip " <br />Owner (Mortgagor) <br />Biliing Name , _ <br />Connection By <br />DESCRIPTION: <br />Lot <br />Block_ <br />Division or Addition <br />T....n Pormit• <br />Utility Account Nc <br />Connec!ion Permit <br />C�nnection Fee_ <br />Total Fee_ <br />Signed <br />� ..._ - , - <br />_ _ � _Z�_ .:� <br />__�_�.� <br />Sewer District <br />Monthly Sewer Service. <br />Monthly Sewer Constr. <br />a <br />SEE SKETCH ATTACHED <br />Lateral <br />Abutting Lot Line <br />N,S,E,VJ <br />Approved By <br />Ciry Engineer <br />Issued <br />i��o S'S ��.C. i' <br />Inspection By l'� � <br />Date I nspected 4— ��—�7 l <br />N0. ;' � ;', ',"1 � 1 <br />ft. <br />