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everen <br />� <br />City of Everett <br />Engineering Department <br />5ewer Application ar:d Permit <br />NO. Z(�`��� DATE <br />Service Address -- <br />Biiling Address — <br />City, State, Zip — <br />Owner (Mortgagor) <br />Billing Name <br />Connection By <br />DESCRIPTION: <br />Block <br />qivision or Addition <br />Tvoe Pa .�nit: <br />Utility Account No. <br />Connection Permit I <br />Connection Fee_ <br />Total Fee <br />Signed <br />c��i,.-;. : <br />Sewer District <br />Monthly Sewer Service. <br />Monthly Sewer Constr. <br />Trunk <br />SEE SKETCH ATTACHED <br />IP,6I'�Cl li���`! <br />Abutting Lot Line <br />N, S, •E, W. <br />Approved By_. <br />Ci•y Engineer <br />Issued <br />Inspection <br />Datelnspe <br />N0. n[ii1�i ; <br />