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everett <br />� <br />City of Everett <br />Engineering Department <br />Sewer Application and Permit <br />N0. �.� DATE <br />Sarvice Address <br />Billing Address _ <br />City, State, Zip_ <br />Owner (Mortgagor) <br />Billing Name <br />Connection By _ <br />Phone <br />UESCRIPTION: <br />Lot <br />Block <br />Division or Addition. <br />Type Permit: <br />Utility Account Nc <br />Connection Permit <br />Connection Fee_ <br />Total Fee <br />Signed <br />Customer <br />SEESKETCH ATTACHED <br />Sewer District <br />Monthly Sewer Service__ <br />Monthly Sewer Constr. <br />Trunk_ <br />�ateral <br />Abutting Lot Line <br />N, S, E, W. <br />Approved By <br />Ciry Enpineer <br />Issued <br />Inspectian <br />)atelnsoe <br />N0. � ��;:. <br />