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� <br />everett <br />� <br />City of Everett <br />Engineering �epartment <br />Sevver �p�pliea4�ion ane� Perrnit <br />N0. DATE <br />Service.4ddress_�-1� � �"CN ��✓� � <br />Billing Address _ <br />City, State, Zip_ <br />Owner (Mortgagor�. — <br />Billing Name__ — <br />Connection By__ _ <br />Address _ <br />Fhone_-- <br />DESCRIPTIOPd: <br />Lot _� <br />Block <br />Divisior or F.ddition. <br />Utility Accou it No._ <br />Connection Permit F <br />Connection Fee_ <br />Total Fee__ <br />Sioned <br />vi <br />SEESKETCH ATTACHED <br />Sewer District___ <br />Monthly Sewer Service. <br />Monthly Sewer Constr. <br />Trunk <br />Abutting Lot Line <br />�,S,E,W <br />ft. <br />Approved sy _ <br />Ciry Engincer <br />Issued <br />Inspection By�-� -y=- <br />Date Inspected � �3/7 % <br />N0. <br />