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e:eretY <br />� <br />City of Everett <br />Engineering Department <br />� '' - <br />l ; /�` ��_ . <br />, � ` .� _ <br />� � � <br />; /� /-� � <br />� � � - <br />� ; ;,,,�� <br />,,, <br />Sewer Application and Permit <br />N0. 2 Q 9 J 1, DATE <br />Service Address <br />Billing Address <br />City, State, Zip - <br />Owner (Mortgagor) <br />Billing Name <br />Connection By_ <br />DESCRIPTION: <br />Lot <br />Block <br />Division ar Addition <br />Tvne Permit: <br />Utility Account No. <br />Connection Permit I <br />Connection Fee_ <br />Totai Fee <br />_ Signed <br />Customer <br />a <br />SEE SKETCH ATTACHED <br />$BW.'f �IStfICt <br />Monthly Sewer Service <br />Monthly Sewer Cons!r. <br />Trunk _ <br />Abutting Lot Line <br />N, S, E, W <br />Approved By_ <br />Ciry Enginecr <br />Issued <br />Inspection By��/� � � <br />Date Inspected � �� �% <br />/V/ �'� NO. ^ , � ' <br />.3r.� <br />