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everett <br />� <br />City of Everett <br />Engineering Department <br />Sewer Applica��on �and Permit <br />N0. � ' <br />DATE <br />� `)�r �; ��'��;1 � � — <br />Service Address ` <br />Billing Address ---- <br />City, State, Zip <br />pwner (fNortgagor) <br />Billing Name <br />Connection BL�__ <br />Address <br />Phone <br />DESCRIPTION: <br />Block�-- <br />Divisicn or Addition <br />/" Q � j `r �� <br />�'-18 z8-s <br />Utility Account No. <br />Connection Permit i <br />Connection Fee_ <br />Total Fee <br />Signed Custom <br />Sewer District <br />Monthly Sewer Service. <br />_ Monthly Sewer Constr. <br />SEE SKETCH Al"TACHED <br />�butting Lot Line <br />N, S, E, W <br />q�70fOVBd BY Ciry Engineer <br />I ssu ed <br />Inspection By ��- `�_ �u�� <br />Date I r.spected � �� � �� <br />vo. 214E2 <br />