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everett <br />�e <br />City of Everett <br />Engineering Department <br />, -�_ f��. <br />r� _ <br />� -, <br />- , � ��� <br />;', <br />Sewer Application and Permit <br />NO. `� O G � � DATE <br />Service Address <br />Billing Address � <br />City, State, Zip <br />Owner jMortgagor) —_ <br />Billing Name <br />Connection BV <br />DESCRIPTION: <br />Lot <br />Block <br />Division or Additinn <br />Tvne Permit: , <br />Utility Account No._ <br />Connec[ion Permit Fee <br />Conneciion Fee <br />Total Fee <br />Signed <br />SEE SKETCH ATTACHED <br />Sewer District <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Lateral <br />Abutting Lot Li�e <br />N, S, E, W <br />Approved By <br />c��v e��a��,��•� <br />Issued B <br />Inspection By <br />Date Inspe�:ted . <br />na ^ �; �_� ��� �� <br />