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u <br />everett <br />� t( <br />City of Everett <br />Engineering Department <br />(� <br />1 f ��, � , ., . <br />� <br />J v• <br />� 9 � �,, <br />� � � <br />� <br />Sewer Application and Permit <br />N0. 2 O G(� DATE <br />Service Address <br />Billing Address <br />City, State, Zip <br />Owner (Mortgsgor) <br />Bilfing Name <br />Connection By <br />Address_ <br />DESCRIPTION: <br />Lot <br />Qlock <br />Division or Addition. <br />Tvnn Parmit: <br />Utility Accaunt Nc <br />Connection Permit <br />Connection Fee_ <br />Total Fee_ <br />Signed <br />uswmer <br />Sewer District <br />Monthly Sewer Service, <br />Monthly Sewer Constr. <br />SEESKETCH ATTACHED <br />At�utting lot Line <br />N, S, E, W. <br />Approved By <br />Ciry Enginecr <br />Issued <br />,/� �i <br />I�spection By�`1L — <br />Date Inspected `��JJ�� � <br />NO. ' <br />