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evereH <br />e �- <br />City of Everett <br />Engineering Oepartment <br />�` `� .s �% - �: <br />_�� � _�,� � <br />��'-.z_� <br />Sewer A�aplication and Permit <br />N0. C. d : . , ` DATE <br />Service Address_ <br />Billing Address_ <br />Ciry, State, Zip r <br />Owner (Mortgagor <br />Billing Name_ <br />Gonnection By_ <br />� <br />Phone <br />DESCRIPTION: <br />Lot __ <br />Biock_ <br />Division or Addition <br />Type Perrr,it: <br />Utility Account No. <br />Connection Permit I <br />Connection Fee_ <br />Total Fee _ <br />Signed -- <br />Customer <br />a <br />SEE SKETCH ATTACFlED <br />Sewer District <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />'rru nk <br />Abutting Lot Line <br />N, S, E, W <br />Approved By <br />City Engineer <br />Issued B <br />Inspection By �� ��• � ��"•�� �`� <br />Datelnspected_ 7 -- ? --� � <br />N0. =l�qG <br />