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everen <br />� f/ ;' . <br />_._� . <br />City of Everett ' <br />Engineering Department <br />Sewer Application and Permit <br />NO. `Z O G� 3 DATE <br />Service Address��ZQ�—� ��-� � S2e <br />Billing Address <br />City, State, Zip <br />Owner (Nlortgagor) <br />Billing Name <br />Connection Bv —_ <br />DESCRIPTION: <br />Lot _ <br />Division or Addition <br />Type Permit: <br />Utility Account No.. <br />Connection Permit F <br />Connection Fee_ <br />Total Fee <br />Signed <br />Customer <br />SEE SKETCH ATTACHED <br />i,��,r,�,i; . <br />S0W0f �ISlfICY — <br />Monthly Sewer Service _ <br />Monthly Sewer Constr. <br />Lateral <br />Abutting Lot Line <br />N, S, E, W. <br />Approved By <br />� City Engineer <br />ISSUC(j <br />Inspection By <br />Date I nspected <br />N0. '��(�� : <br />