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everPtt• <br />e <br />City of Everett <br />Engineering Department <br />Sewer Appli�ation and Permit <br />NO. �� J. -' �::".�` DATE <br />Service Address_ <br />Billing Address_ <br />City, State, Zip_ <br />Owner (Mortgago <br />Billing Name_ <br />Connection BY_ <br />Phone <br />DESCRIPTION: <br />Lot <br />Block <br />Division or Addition <br />Tvoe Permit: <br />Utility Account No <br />Connection Permit <br />Connection Fee_ <br />Total Fee <br />� `.�_ ,�" _, <br />,-.}�� � <br />Y � JfIA R. <br />V�� <br />' �' P <br />�r <br />Signed — <br />Customer <br />a — <br />SEE SKETCH ATTACHED <br />Sewer District' � � <br />Monihly Sewer Service. <br />Monthly Sewer Constr. <br />Abutting Lot Line <br />N, S, E, W <br />Approved f3y — <br />Ciry ''_ngineer <br />I ssued <br />Inspection By_1.5� — <br />Date Inspected_ ` � — <br />N0. � i_`��I! <br />