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B <br />everetl <br />e <br />City of Everett <br />Engineering Department <br />Sewer Application and Permit <br />NO. - DATE <br />Service Address��� %� iH �"�` Utility Account No. <br />Billing Address <br />— Connection Permit I <br />City, State, Zip Connection Fee <br />Owner (Mortgagor) Total Fee <br />Billing Name <br />Connection Bv <br />DESCRIPTION: <br />Lot r] _ <br />Block_ <br />Division or Addition <br />Type Permit: � <br />Remarks: <br />SEESKETCH ATTACHED <br />__ Siyned_------ <br />— c����„�„—�•� <br />Sewcr District <br />Monthly Sewer Servicc <br />Monthly Sewer Consti. <br />Trunk <br />Lateral <br />Abutting Lot Line <br />N, S, E, W__ __ <br />----- — <br />— -- t. <br />Approved �Y— <br />cnve��o�����.;--- — _ <br />Issued RY - - <br />;ii,p�v.w,n By <br />Date Insocrter <br />rvo. ;' 1 F R R <br />