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�verett <br />� <br />r,;ri of Everett <br />Engineering �epartment <br />; �. <br />_Ti (_� � '_ <br />J � <br />_ % <br />�. <br />,� <br />�„ , <br />Sewer Appaisataon and Permit <br />NO. DATE <br />Service Address <br />Billiny Address <br />City, State, Zip <br />Owner (Mortgagor�_ <br />Billing Name <br />Connection By . __ _ _ <br />DESCRIPTION: <br />Lot <br />Block <br />Division or Addition <br />Type Permit: <br />Remarks: <br />Utility Accuunt No. <br />Connection Permit I <br />Connection Fee_ <br />Total Fee _ <br />Signed <br />Sewer District <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />SEE SI<ETCH ATTACHED <br />Lateral <br />Abutting Lot Line <br />N,S,E,W. <br />Approved By <br />City Engineer <br />Issued By _— <br />Inspection By i�/ /� <br />Date Inspected � �/-7� <br />N0. <br />