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everett <br />� <br />City of Everett <br />En^ineering Ccpartment <br />, i/ � '"' � ' _.._ . . <br />� ii' .7 •. <br />F <br />' ' _ A? � '% �°`�- :F�: <br />Sewer App�lieation and Permit <br />N0. �_ -i ,_ ( ,�; DATE <br />Service Address_ <br />Billing Address— <br />City, State, Zip� <br />Owner (biortg�gor) <br />Billing Name_._ <br />Connection By__ <br />Phone <br />DESCRIPTION: <br />Lot <br />Block_. <br />Division or Add <br />r..__ n......t�• <br />Utility Acco:�nt No.. <br />Connection Permii F <br />Connection Fee_ <br />Total Fee <br />Signed_ c�s �m� <br />Sewer Uistncc <br />Monthly Sewer Service. <br />Monthly Sewer Constr. <br />SEE SKETCH ATTACHED <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />Approved By <br />Ciry Engineer <br />I ssued <br />i� �✓� <br />7� <br />Inspection By �l ? ti'�� '�'L"`�' <br />Datelnspected l'/' ����P <br />NO. ? j �, <br />