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� <br />-=---=-� <br />everett <br />� <br />C�ty of Everett <br />Engineering Uepartnent <br />Sew�r Application and Perm�t <br />N4 ._ . � : _ DATE <br />Service Address_ <br />Billing Address <br />City, Sta+.e, Zip <br />Owner �Mortgagor) <br />Billing Name <br />Connection By <br />Address <br />Phone _ <br />DESrRiPTI��N: <br />Lot <br />Division or <br />Type Permit: <br />Utility Account No._ <br />Connection Permit Fee <br />Connection Fee <br />Total Fee <br />Signed <br />Customer <br />0 <br />SEESKETCH ATTACHED <br />Sewer District <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Laterel <br />Abutting Lot Line <br />N, S, E, W <br />Approved By __ <br />City Engineer <br />Issued <br />ji <br />i.. <br />Insper.tion By_ <'•'': i �.' r,z, __ <br />Datelnspected ��'2�!� ___ <br />N0. <br />