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� <br />rverefi <br />� � <br />U <br />City of Everett <br />Enginecring Department <br />Sewer e4ppliec�tion and Perrnit <br />p� n. <br />Service <br />DATE _ <br />��.i/ <br />Billing Address <br />City, State, Zip _ <br />Owner (Mortgagor) _ <br />Billing Name <br />Connection By <br />Address_ <br />Pnone.___ <br />DESCRIPTION: <br />Lot <br />Block <br />Divisicn or Addition <br />Type °ermit: <br />� �J/ �_ �� <br />!" —�Q�! ?j � <br />_ � <br />�__3- �� <br />j�'�/( <br />Utility Account No. <br />Connection Permit f <br />Connection Fee <br />Total <br />Signed_ <br />SEE SKETCH ATTACHED <br />Cwtomcr <br />Sewer Dist <br />Monthly Sewer Service __ <br />Monthly Sewer Constr. <br />Abutting Lot Line <br />N, S, E, W <br />Approved <br />City Engineer <br />Issued <br />Inspection By__�s� -t�ar,.� <br />Date Inspected '— <br />N 0. � �' <br />