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everett <br />� <br />City of Everett <br />Eng:neering Oepartment <br />,�� _, - . -_.::_, <br />h• J <br />� -- �a G w 2. � +�_ <br />�_ � � <br />,� • � _.. <br />. � � �TA �� - • <br />Sewer Application and Permit <br />NO. � 1 :� +? " DATE <br />Service A�dress <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Name <br />Connection By <br />Address <br />Phone <br />DESCRIPTION: <br />Lot <br />Block <br />Division or Addition <br />u <br />Utility Account No._ <br />Connection Permit Fee <br />Connection Fee <br />Total Fee _ _ <br />Signed <br />Cusromer <br />Sewer District__ <br />Monthly Sewer Service. <br />Monthly Sewer Constr. <br />Trunk <br />Tvpe Permit: -- <br />SEESKETCH ATTACHED <br />Abutting Lot Line <br />N, S, E, W. <br />Approved <br />Ciry Engineer <br />Issued B <br />Inspection By�_ <br />Date Inspected���' 7 — <br />rvo. ? .1 3 (� ' <br />� <br />