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everetl <br />� � <br />City of Everett ' <br />Engineering Departmen[ <br />, • <br />� � --/ _ i��, : <br />�/ r <br />�, <br />5ewer Applicction and Permit <br />NO. �Q� j � DATE �— <br />Service Address Utility Account No. <br />Billing Address Connection Permit f <br />City, State, Zip Connection Fee_ <br />Owner (Mortgagor) Total Fee <br />Billing Name <br />Co�nection By — <br />Address <br />� " <br />Phone <br />DESCRIPTION: <br />Lot <br />Block_ <br />Division or Addition <br />Signed <br />Cus�omer <br />Sewer Distrir,t__ <br />Monthly Sewer Service. <br />Monthly Sewer Constr. <br />a <br />SEESKETCH ATTACHED <br />Lateral <br />Abutting Lot Line <br />W-- - h <br />N, S. F, - ---- <br />Apprr�ved BY-- <br />CiW [��9���esr <br />Issued By <br />Inspection By "__ — <br />Date Inspected v -¢- }e / q.� <br />, -, ,� <br />NO. '�Ii,�' <br />