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everett � ' � _- <br />� � � � „ � � �� ,�% <br />i; ', �S'1`� <br />J <br />f / �C <br />City of Everett <br />Engineering Department <br />Sewer Applicatic�n cnd Permit <br />N0. �f1a�i�•-: i'1 DATE <br />� ; i <br />Service Addres. <br />Billing Address <br />City, State, ZiF <br />Owner (Mortga <br />Billing Name_ <br />Connection By <br />Utility Account No. <br />Connecti�.i Permit f <br />Connection Fee_ <br />Total Fee <br />Signed _ <br />Customer <br />DESCRIPTION: Sewer District <br />Lot <br />Block Monthly Sewer Service. <br />Division or Addition �vlonthly Sewer Constr. <br />Trunk <br />Type Permit: <br />SGE SI<ETCH ATTACHED <br />Abutting Lot Line <br />N, S, E, W <br />Approved <br />e�,n ��„�, <br />Issued By _ <br />ft. <br />Inspection By " �- <br />Date I nspected ' �`' � — <br />N0. <br />