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�v�rren <br />� <br />City of Everett <br />Engineering Department <br />5ewer Application c�nd Permit <br />NO. r. _'_ �: ; J DATE <br />, <br />-'�- % i �� <br />k �3�z� � <br />Service Address Utility Account No. <br />Billing Address :onnection Permit Fee_ <br />City, State, Zip Connection Fee <br />Owner (Vlortgagor)_ Total Fee <br />Billing Name <br />Connection By <br />Address____ Signed <br />Cusmmei <br />1 hGi1B___ � <br />DESCRIPTION: Sewer District _— <br />Lot <br />Block_ Monthly Sewer Service <br />Division or Addition _ Monthly SeH•er Constr. <br />— Trunk <br />r.._., o..__:.. <br />Remarks: <br />SEESKETCH ATTACHED <br />� ;!.: , <br />Lateral <br />Abutting Lot Line <br />N, S, E, W ft. <br />Approved By <br />Ciry Engineer <br />Issued <br />�� ,'�/�/;.� <br />Inspection By� .�"''�"� " <br />Date I nspected � /� ��% <br />�— � , <br />% �j / i <br />N0. �_.. _- _ <br />