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everen <br />e <br />Ciry of Everett <br />Engineering Department <br />Sewer Application c;nd Permit <br />NQ � O J � � DATE _ <br />Service Address <br />Billing Address <br />Ciry, State, Zip <br />Owner (Mortgagor) <br />Billing Name <br />Connection By <br />Address_. _ <br />Phone <br />DESCRIPTION: <br />Lot <br />Block <br />Division or Addition <br />Type Permit: <br />Utility Account No <br />Connection Permit <br />Connection Fee_ <br />TOIaI Fee <br />Signed <br />Sewer District <br />Monthly Sewer Service <br />Monthly Sewer Co�istr. <br />Trunk <br />Lateral <br />Abu[ting Lot Line <br />N, S, E, lN___ -- --ft. <br />Approvr.d (3 <br />SSUL'lI BY._ ___ "_ <br />— 7 <br />--- _ <br />--- In;pci_Iiun bY- <br />----- <br />y ---- - - - -- ----�Da[e Inspr.cted.-- _ <br />SEESKETCH ATTACHED <br />Iv Enpinecr <br />NU <br />