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ever n __ <br />� �l - �- 2`� _�� �� i _� � <,�'/��- <br />� ,-�. � _ �`, , � <br />� ' ; <br />City of Everett <br />Engineering Department <br />Sewer Application and Permit <br />N0. ?�C�OQ <br />Service Address - ' <br />, <br />DATE '�` <br />Billing Address_ �� `' <br />_ , � ; <br />City, State, Zip '`" <br />Owner (Mortgagor) -� �' �'-� <br />Billing Name % i= '�' - <br />Connection By . l� -•�JF�; i ,<__ � ,�,i.-i %�: <br />Address ',�_"/- �i1,-,�,��< ��'�:: � <br />Phone -' � <br />Utility Account N <br />Connection Permit Fee % � ' • %� ' <br />Connection Fee �' ' � /�� � ` <br />Total Fee � <br />Signed <br />CESCRIPTION: Sewer District <br />Lot � <br />Block " Vlonthly Sewer Service � �' <br />� _ . I ; <br />Division or Addition L'i �% %"�� � �� '" � Monthly Sewer Constr. <br />Trunk . . ! � I <br />Type Permit: <br />SEESKETCH ATTACHCD <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />Approved By - <br />c��v <br />issued By _ <br />ngineer <br />_ / <br />/ <br />Inspection By_��/k� //�'U'�' — <br />Date lnspected /�-�— 7� __ <br />N 0. �„� n�,, r <br />�. <br />