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everett <br />� <br />City of Everett <br />Engineering Oepartment <br />Sewer Application and P�rmit <br />N0. ; !_ ' '. DATE <br />Service Address <br />Billing Address <br />City, St�te, Zip <br />Owner (Mortgagor) <br />Billing Name <br />Connection By — <br />Phone <br />DESCRIPTION: <br />Lot <br />Block <br />Divisio�i or Addition <br />Tvoe Permit: , <br />�, -. - <br />t <br />. _ t. ,�J <br />i(,. 1 <br />Utility Account No. <br />Connectior. Permit i <br />Connection Fee_ <br />Total Fee <br />Signed_ <br />SEE SKETCH ATTACHED <br />Sewer Di�trict <br />Monthly Sewer Service. <br />Monthly Sewer Constr. <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />Approved By <br />Ciry Engineer ' <br />Issued <br />Inspection <br />Date InsAe <br />N0. �'.L�.�!) 2 <br />