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' everett <br />� <br />City of Everett <br />Engir.eering Departmeni <br />Sewer Application and Permit <br />N0. �- DATE <br />Service AddressTg � � /} �—���-�� Utility Account No. <br />Billing Address Connection Permit <br />City, State, ZiP Connection Fee_. <br />Owner (Mortgagor) Total Fee <br />Billing Name <br />Connection <br />DESCRIPTION: <br />LOt�i_� lA <br />Block �/� <br />Division or Addition <br />Type Permit: <br />�E�aur.,GFT <br />–" 1 <br />SEESKETCH ATTACHED ; � <br />Signed <br />Customer <br />Sewer District__ <br />Monthly Sewer <br />Monthly Sewer Constr. <br />Lateral <br />Abutting Lot Line <br />N, S, E, W. <br />Approved <br />City Engineer <br />Issued B <br />/ i <br />Inspection By �`- .� ✓ <br />Date lnspec.ed `Z���/T% <br />N0. � <br />