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everett <br />e <br />City of Everett <br />Engineering Uepartment <br />,>.- Z'( � . <br />;;;,. �,-.,� '—'�.��:.�,�� <br />Sewer Application cnd Perm�t <br />No. 2Q632 DATE <br />Service Address <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Plame <br />Connection By <br />Phone <br />DESCRIPTION: <br />Lot _ <br />Block. <br />Division or Addition <br />Type Permit: <br />Utility Account No. <br />Connection Permit Fee <br />Conner,tion Fee <br />Total Fee <br />Si <br />SEESKETCH ATTACHED <br />Sewer District <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />La tera I <br />Abutting Lot Line <br />N, S, E, W <br />Approved By <br />City Enginmr <br />Issued <br />Inspection By ��P � K C <br />�ate I nspected��7 � <br />NO. 'J��F`�n <br />,� � , � <br />� .> � <br />