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e <br />00 <br />City of Everett <br />Engineering Department <br />Sewer Application and Permit <br />NO. <br />Service Address_ --- <br />Billing Address --- <br />City, State, Zip _ <br />Owner (Mortgagor) <br />Billing Name <br />Connection By <br />DESCRIPTION: <br />Lot <br />Block <br />Division or Addit <br />Type Permit: <br />DATE <br />SEE SKETCH `,CHED <br />�o s v LET <br />z <br />��-- P r <br />Utility Account No, <br />Connection Permit Fee_ <br />Connection Fee <br />Total Fee_ <br />Signad <br />Cueromer -- <br />Sewer District <br />Monthly Sewer Service <br />Monthly Sewer Constr, <br />Lateral <br />Abutting Lot Line <br />N,S,E,W. <br />Approved By <br />City Engineer <br />Issued <br />Inspection By <br />)ate Inspected <br />No. 21277 <br />