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everett , <br />j� A L;. ', i j _' <br />_ � , <br />City of Everett <br />Engineering De-•rtment <br />Y�' <br />5ewer AppOiccati�n and Pe�rmit <br />N0. ;: U `; =y :: DATE <br />Service Address <br />Billing Addre;s_ _ <br />City, State, Zip <br />Owner (Mortgagor) _._ <br />Billing Name _ <br />Connection By _ <br />Address <br />DESCRIPTION: <br />Lot _ _ <br />Block____ <br />Division or Addition <br />Type Permit: <br />Utility Accc,unt No.. <br />f;onner.tion Permit F <br />Connection Fee_ <br />-���1 C.. <br />Signed <br />SEE SI<ETCH ATTACHED <br />Sewer District <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />7runk <br />Lateral <br />Abutting Lot Line <br />N, S, E, W, <br />Approved <br />City Engincer <br />Issued <br />1 <br />Inspection By_ - ' �- % <br />Date Inspected_�6 z ` � � <br />N0. `� (I �= �' , <br />_ J �: .� <br />