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ey� � <br />� <br />City of Everett <br />Engineering Department <br />� � � �� � � � <br />� _ � � ` — `i '- <br />., . � <br />� �� S "C"� � /;' - Z /" / � <br />� ��� . <br />, �> <br />1 <br />Sewer Appli�ction and Permit`` <br />NO. � 10 6 � DATE <br />Service Address <br />Billing Address <br />City, State, Zip_ <br />Owner (Mortgagor) <br />Billing Name <br />Connection Bv— - <br />Phone_ <br />DESCRIP i ION: <br />Lot <br />Block <br />Division or Addition <br />Type Permit: <br />Remarks: <br />SEE SKETCH ATTACHED <br />-,, : <br />Utility Account N� <br />Connection Permit <br />Connection Fee_ <br />Tctal Fee_ <br />Signed <br />Customer <br />Sewer District <br />Monthly Sewer Servicc <br />PAonthly Sewer Constr. <br />Lateral <br />� Abutting Lot Line <br />N, S, E, W <br />Approved By_. <br />Qry Engmeer <br />I ssue� <br />Inspection By C'`�tl, Ic�� �2 F1 <br />J <br />Date I nspected �^�. �'- 7 � <br />N0. � � � ' <br />