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evereri <br />� <br />City of Everett <br />Engineering Department <br />Sewer App�ication and Permit <br />N0. ._ _ _ DATE <br />Service Address <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor) <br />Billiny Name_ <br />Conneciion By <br />Address <br />Phone - <br />DESCRIPTION: <br />Lot <br />Block <br />Division or Addition <br />T.inn Pnrmit• <br />, /G! z-2 <br />�3_-7� <br />Utility Account No. <br />Connection Permit I <br />Connection Fee_ <br />Total Fee _ <br />Si <br />Sewer District <br />Monthly Sewer Service. <br />Monthly Sewer Constr. <br />3 <br />SEE SKETCH ATTACHED <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />�pproved By <br />Ciry Engineer <br />Issued <br />Inspection By �� "r ^ �����T� <br />Date Inspected �` '� � <br />N0. ^ `' . <br />