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e <br />everetl <br />City of Everett <br />Engineering Department <br />Sewer Application and Permit <br />NO. r_ L 'U l 1 ij DATE Service Address? ��Z�0'/� <br />J- <br />Billing Address <br />City, State, Zip___ <br />Owner (Mortgagor) <br />Billing Name <br />Connection By <br />Phone <br />DESCRIPTION: <br />Lot <br />Block <br />Division or Addition <br />Tvne Permit: <br />SEE SKETCH ATTACHED <br />Utility Account No <br />Connection Permir Fee_ <br />Connection Fee <br />Total Fee_ II II <br />Signed - <br />Cuttomr <br />Sewer <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Lateral _ <br />Abutting Lot Line <br />N, S, E, W <br />Approved By <br />City Enpinem <br />Issued <br />Inspection By <br />Date Inspected Ila YZ 7 <br />NO. 2 1 G 0 8 <br />