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ev2retl <br />e <br />City of Ever�tt <br />Engineering Oepartment <br />Sewer Application and Permit <br />N 0. D ATE <br />Service Address <br />Billin3 Address <br />City, State, Zip <br />Owner (Mor[gayor) <br />Billing Name <br />Connection By <br />Address <br />Phone <br />DFSCRIPTION: <br />Lot <br />Block <br />Division or Addition <br />Type Permit: <br />Remarks: <br />o------- --------- <br />SEESKETCH ATTACHED <br />Utility Account No. <br />Connection Permit I <br />Connection Fee <br />Total Fee_ <br />Signed <br />- � Z� _ ,. <br />, - �5 — 7e� <br />Sewer District <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Trunk__ <br />Lateral <br />Abutting Lot Line <br />N, S, E, VJ <br />Approved By <br />Qty Enpmem <br />I SSU@(J <br />Inspection By ' �y�b'� <br />Date I nspected_ _ 3 in �� <br />fVO. <br />