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everett <br />� <br />Ciry of Everett <br />Engineering Department <br />� <br />� <br />%��_ _� _ _ .,, � ; <br />,, <br />, <br />Sewer Ap�plicat0on cnd Permit� <br />N0. 2 O y�_ � ��'TE � <br />Service Address Utility Account No. <br />Billing Address _— Connection Permit I <br />�ity, State, Zip Connection Fee_ <br />Owner (Mortgagor) Total Fee <br />Billing Name <br />Connection By <br />Address Signed_ <br />Customer <br />Phone _ <br />DESCRIPTION: Sewer District <br />Lot <br />Block Monthly Sewer Service <br />Division or Addition Monthly Sewer Constr. <br />_ _ . Trunk <br />Remarks: <br />3 <br />SEESKETCH ATTACHED <br />�.3��.�� <br />Abutting Lot Line <br />N. S, E, W ft. <br />Approved By_ <br />Ciry Engincer <br />ISSUBCJ <br />Inspection By <br />Date Inspected <br />NO. c'. , <br />