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everett <br />� - � <br />City of Everett <br />Engineering Department <br />Sewer Application and Permit <br />N0. i ; � , DATE <br />Service Address <br />Biliing Address <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Name <br />Connection By <br />Phone <br />DESCRIPTION: <br />Block � �/— �� - z `� � S <br />Division or Addition <br />Type Permit: <br />��rr''��.lED <br />. IIUG 30 '�9� . <br />UTIIIiY DEPP'diMENT <br />Utility Account No.. <br />Connection Permit F <br />Connection Fee_ <br />Total Fee <br />Signed <br />Cuslomcr <br />p <br />SEESKETCH ATTACHED <br />Sewer District <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Lateral <br />Abutting Lot Line <br />N, S, E, W_ <br />Approved By <br />City Engineer <br />ISSUBd <br />� ' <br />Inspection By�� �i <br />Datelnspected � — ,2� — 7 % <br />N0. <br />