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everett <br />e <br />City of Everett <br />Engineerir.g Department <br />Se�er Appli�ation and Perrnit <br />NO. % _!. ;' ;�'�_: DATE <br />Service A'ddress Utility Account <br />Billing Address <br />City, State, Zip <br />G�aner (Mortgagor) <br />Billing Name <br />Connection BY <br />DESCRIPTION: <br />Lot - <br />Block <br />Division or Addition <br />Tvne Permit: <br />Connection Permit <br />Connection <br />Total <br />G..�',�`J <br />.��`�`'� �� <br />�--..� � - ��--� <br />�' - 2 �}- - 7� <br />� � � �'�-- • <br />!- <br />Signed '�' <br />Cusromer <br />Sewer p <br />Monthly Sewer <br />,^.Sonthiy Sewer Constr. <br />SEE SKETCH ATTACHED <br />Abutting Lot Line <br />N, S, E, W, <br />Approve� By ' <br />Ciry Engineer <br />I SSU EC� <br />Inspection By 'L <br />Datelnspected ���� b — <br />N0. � � n C �> <br />