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e4erett <br />City of Everett <br />Engineering Department <br />Sewer Application and Permit <br />NO. DATE <br />Service Address p p :i= Utility Account No. <br />Billir,Address <br />City, State, Zip <br />Connection Permit Fee <br />Connection <br />Owner (Mortgagor) Total Fee <br />Billing Name <br />Connection By <br />Address <br />DESCRIPTION: <br />Lot 8 <br />Block <br />Division or Addition <br />SEE SKETCH ATTACHED <br />Signed _ <br />Cuxom f <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 Enginex <br />Issued <br />Inspection By <br />Date Inspected 3 �0 7 7 <br />NO. EiG <br />