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-everett ' ' � ' - <br />! _ r-- f,, <br />e � � l��,r�� <br />f � ;�`j���� <br />City of Everett <br />Engineering Oepartment , �'� <br />�. <br />Sewer Application and Permit <br />Na 2' u�O <br />Service Address_ <br />Billing Address_ <br />City, State, Zip� <br />Owner (Mortgagor) <br />Billing Name_ <br />Connection Qy_ <br />DESCRIPTION: <br />Lot <br />Block <br />Division or Addition <br />DATE <br />Utility Accaunt No.. <br />Connection Permit F <br />Connection Fee_ <br />Total Fee <br />Signed <br />Cusiomer <br />SEESKETCH ATTACHED <br />Sewer District — <br />fvlonthly Sewer Service <br />Monthly Sewer Constr. <br />Lateral <br />Abutting Lot Line <br />N, S, E, W. <br />Approved <br />Engineer <br />Issued BY <br />Inspection By �V • �✓`-a"`�� <br />Date 1 nspected 9/C- �-f <br />N0. <br />