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everen <br />� <br />City oi Everett <br />Engineering Department <br />Sewer Application and Permit <br />N0. <br />DATE <br />Service Address <br />Billing Address _ <br />City, State, Zip _ <br />Owner (Mortgagor) <br />Billing Name <br />Connection By_.___._ _ _ <br />DESCRIPTION: <br />Lot <br />Block__ <br />Division or Add <br />Tvne Permit: <br />Utility Account No. __ <br />Connection Permit Fee_ <br />Connection Fee <br />Total Fee_ ____ _ _ <br />Signed <br />c�:�ome� <br />SEE SKETCH ATTACHED <br />Sewer District <br />Monthly Sewer Service_ <br />fNonthly Sewer Constr. <br />Lateral <br />Abutting Lat Line <br />N, S, E, W __ <br />Approved By <br />ciry E�qioeor <br />Issued <br />;� <br />�% I � �' � .cl-.f� <br />f <br />Inspection By �' � ��{�%�� — _ <br />�ate Inspected_ �� li7/ �/ <br />,- W ---- <br />NO. ',' � ? ' <br />