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•e-�ereit <br />� <br />Ciry of Everett <br />Engincering Department <br />Sewer Application <br />,;. <br />N0. �_ : i :' DATE <br />• <br />and Permit <br />�- <br />Service Address J��i n � 1U/J D ��F- <br />Billing Address <br />City, Siate, Zip <br />Owner (Mortgagor) _� ._ G �..-/iS� �SLG��%�-- <br />Billing Name <br />Connection By <br />Phone <br />DESCRIPTION: <br />Lot <br />Block — <br />Division or Addition <br />Tvae Permit: <br />Utility Account No.. <br />Connection Permit F <br />Connection Fee_ <br />Total Fee <br />Signed <br />Cuslomer <br />Sewer District <br />Monthly Sewer Service. <br />Monthly Sewer Constr. <br />SEESKETCH ATTACHED <br />Lateral <br />Abutting Lot �inc <br />N, S, E, W <br />Approved By <br />Ciry Engineer <br />Issued <br />Inspection By <br />Datelnspected —��� <br />� _. <br />NO. ', !ijC! <br />