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„ evprett <br />I� <br />� <br />City of Everett <br />Engineerin7 Department �� <br />Q <br />Sewer Application and Perrra�t <br />N0. r_ �_ ��. �� �_� DATE <br />Service Address __ <br />Billing Address _ <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Name <br />Connection Bv— _ _ . <br />DESGRIPTION: <br />Lot � � � <br />Block <br />Division or Addition <br />Type Permit: <br />__ ___ <br />/;' �, ��� f � <br />�'' ; � � _7 i <br />7 �;T __ G <br />�� <br />Utility Account No. <br />Connection Permit Fee <br />Connection Fee _ <br />Total <br />Si <br />( Sewer District_ <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />SEESKETCH ATTACHED <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />Approved By <br />Ciry Engineer <br />Issued <br />Inspection By <br />Dete Inspected_�L�"� — <br />Pl O. `% ! ;. ;' i � <br />