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everett <br />� <br />City of Everett <br />Enginearing Department <br />Sewer Applicct�on and Permit <br />N0. �_ i � � �. i DATE — — <br />Service Address <br />Billing Address <br />City, State, 2ip <br />Owner (Mortgagor) <br />Bil!ing Name <br />Connection By <br />Phone _ <br />DESCRIPTION: <br />L.ot _ <br />Block <br />Division or Addition <br />—� r � <br />�� s,i � <br />�_��ZB'� <br />Utility Account No. <br />Connection Permit Fee _ <br />Connection Fee <br />Total Fee <br />Signed_ <br />Customer <br />e <br />SEESKETCH ATTACHED <br />Sewer District _ <br />Monthly Sewer Service __ <br />Monthiy Sewer Constr. <br />Lateral <br />Abutting Lot Line <br />N, S, E, W. <br />Appraved <br />ciry <br />ISSUt(J B <br />Inspection By _ <br />Date Inspected <br />'J0. ��1�:I�,' <br />