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everett <br />e <br />City of Everett <br />Engineering Department <br />Sewer App���ation and Permit <br />N0. � �-�:�I.`,s <br />Service Address_ <br />Billing Address_ <br />City, State, Zip_ <br />Owner (Mortgagor) <br />Billing Name <br />� nection <br />DATE <br />.�e s 7`�r�..� � <br />�,� ,� _�.. <br />. � -' z--� � .� <br />l.�J � <br />Utility Account No. <br />Connection Permit <br />Connection Fee � <br />Total r <br />on -.— <br />�f /'y � D % ned <br />�/i9�J fi•s+•u "� nJ� ! �. _-�— S�9 ,.Customer <br />Address •�' <br />Phone '�'�; � �v � � <br />DESCRIPTION: <br />Lot �-- <br />Block�— <br />Division or Addition <br />,a . <br />Sewer �istrict_ <br />��7 �' ;�, <br />Monthly Sewer Service , � <br />Monthly Sewer Constr. <br />SEE SKETCH ATTACrftu <br />INSPECTION <br />Trunk � ` <br />Lateral <br />\butting Lot Line <br />N, S, E, W <br />4pproved By �i�y Engineer <br />Issued <br />�nspection By <br />�J�AN ��� <br />Date Inspected ��� <br />No. 21_ 5 l'�' <br />