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everett <br />� <br />City of Everett <br />Engineering Department <br />Sewer Applieation and Permit <br />N0. DATE � <br />Service Address _ Utility Account No. <br />Billing Address Connection Permit f <br />City, State, Zip Connection Fee_ <br />Owner (Mortgagor� Total Fer. <br />Billing Name <br />Connection By <br />Address Signr.d <br />DESCRIPTION: <br />Lot <br />Biock <br />Divisio� or Add <br />Type Permit: <br />0 <br />SEESKETCH ATTACHED <br />-`7 _ � .�3 <br />ustamcr <br />Sewer Distr,ct_ _ _ <br />Monthly Sewer Service__ __ <br />Monthly Sewer Constr. <br />Lateral_ <br />Abutting Lot Line <br />N, S, E, W <br />Approved <br />cny e„q�„«� <br />Issued By <br />Inspec�ion 8y—__ -- --_ <br />Date Inspected � ' <br />N0. <br />f t. <br />