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;erett <br />�� � <br />City of Everett <br />Engineering Department <br />S�v+rer App�ication and Permit <br />NO. r_ .'_ �` f "; DATE <br />Ser�ice Address <br />Billing Address__ <br />City, State, Zip <br />Owner (14ortgagor) <br />Billing Name <br />Connectian By <br />Address <br />Utility Account Nc <br />Connection Permit <br />Connect��n Fee <br />7otal Fee <br />Si <br />_..._�.'%-- ,�•�=-- "� <br />i=' � . <br />Phone_ <br />DESCRIPTION: Sewer ��istrict _ <br />Lot <br />Block Monthly Sewer Service <br />Diaision or Addition Monthly Sewer Constr. <br />Trunk <br />Tvoe Permit: <br />SEESKETCH ATTACHED <br />Latera <br />Abu:ting Lot Line <br />N, S, E, W_ <br />Approved <br />6�gineer <br />I ssued <br />i ��., <br />lnspection By ����Z�'-��--� <br />Da?e I nspecteo����'6 <br />rvo. %� 1_ "' r". <br />