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everett <br />e <br />City of Everett <br />Engineering Uepartment <br />�-,��� <br />� �� _Ze-s- <br />Sewer Application and Permit <br />NO. C. .1 :' ,` '.' DATE <br />Service Address <br />Billing Address_ <br />City, State, Z?� <br />Owner (Mortgagcr) <br />Billinc :'ame <br />Connection By <br />Address <br />DESCRIPTION: <br />Lot _ <br />Block _._ <br />Division or Acdition <br />Tvoe Permit: <br />Utility Account No. <br />Connection Permit I <br />Connection Fee_ <br />Total Fee <br />Signed — <br />cuttomer <br />Sewer District - — <br />Monthly Sewer Service — <br />Monthly 5ewer Constr. <br />Trunk <br />Lateral <br />SEIc SKETCH ATTACHED <br />I i�� `�P �C110N <br />tting Lot Line <br />N, S, E, W <br />�oved By <br />Ciry Engineer <br />ection By <br />Inspected <br />rvo. 214 9'r'' <br />