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everett <br />� <br />City of Everett <br />Engineering Department <br />Sewer Applic�tion and Permit <br />N0. LOG�.� <br />Service Address_ <br />Billing Address_ <br />City, State, Zip_ <br />Owner (Mortgagor) <br />Billing Name_ <br />Connection By_ <br />Address <br />DESCRIPTION: <br />Lot _--�— <br />Block <br />Division or Addition <br />DATE <br />l,�tility Account No. <br />Connectian Permit I <br />Connection Fee_ <br />Total Fee <br />$19f1Cd Cusmmer <br />$ewer District <br />Monthly Sewer Service. <br />Monthly Sewer Constr. <br />a <br />SEE SKETCH ATTACHED <br />Lateral <br />�,butting Lot Line <br />N,S,E,W <br />4pproved By Ciry Engineer <br />issued <br />Inspection By �� <br />Datelnspected � /z� <br />No. �0643 <br />