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everett <br />� <br />City of Everett <br />Engineering Departme�t <br />- ; <br />_, . ; � - �� <br />� <br />..: �; � Z i 7i <br />>> -;,>n ��� �,� <br />� . ,,� ,,.; ;�� �- <br />,. � ': . <br />� <br />Sewer App�ication and Permit <br />No. ? 0 6 2 2 DATE -;: -- <br />Service Addre:s <br />Billing Address <br />City, State, Zip � <br />Owner (Mortgagor) +� ' <br />Billing Name_ <br />�onnection By <br />0!�l�fPCC � � . .. .. � . . <br />DESCRIPTION: <br />Lot <br />Block <br />pivision ar Addition <br />Type Permit: <br />Utility Account No. � <br />Connection Permit Fee -- <br />Connection Fee - _. <br />Total Fee � <br />� <br />i�;±�� , .. ^r',:'�i:, :' � :�sl `_. , . , . . , - <br />Signed_ '-iJlp,,,/ _' ^ _ <br />` Cusromer� � � ' " <br />SEE SKETCH ATTACHED <br />idtif,i=�.._�.i ...., i <br />Sewer District -- " <br />vluntitly Sawe� Service - <br />Monthly Sewer Constr. <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />App�oved By � <br />City Engineer � � <br />Issued Bv _ — <br />Inspection By � Gri/�<„j� _ <br />Date Inspected � o •ry <br />N0. ^j�� �L, <br />R <br />— l� <br />