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cvcreli <br />City of Everett <br />Engineering Department <br />%0 <br />Sewer Application and Permit <br />NO. <br />DATE <br />Service Address..74 2 9hi"-/i?. 57,6— <br />Billing Address <br />City, State, Zip_ <br />Owner (Mortgagor)_ <br />Billing Name <br />Connection By_ <br />Utility Account No. <br />Connection Permit I <br />Connection Fee_ <br />Total Fee___ <br />Signed <br />Customer <br />DESCRIPTI N: Sewer District <br />Lot_ <br />Block— Monthly Sewer Service <br />Division or Addition�_a//L, Monthly Sewer Constr. <br />Type Permit: <br />Remarks: <br />0 <br />SEE SKETCH ATTACHED <br />Lateral <br />Abutting Lot Line <br />N, S, E, K <br />Approved By_ <br />City Engineer <br />Issued <br />Inspection <br />Date Inspected - <br />r <br />