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everett <br />� <br />City of Everett <br />Engineering Department <br />Sewer Application and Permit <br />�O. <br />DATE <br />Service Address_ Utility Account No <br />Billing Address Connection Permit Fee _ <br />City, State, Zip � Comection Fee <br />Owner (Mortgagor) Total Fee <br />Billing Na <br />Conr.ection By <br />�.. <br />Phone <br />DESCRIPTIOIV: <br />Lot _ <br />Block <br />Division or A�idition <br />Type Permit: <br />Signed _ <br />Cus[omcr <br />Sewer District ___ <br />Monthly Sewer Ser�ice _. _ <br />_ Monthly Sewer Constr. <br />— Trunk <br />Lateral <br />Abutting �ot Line <br />N, 5, E, W --- <br />a <br />SEESKETCH ATTACHED <br />Approved By _ <br />Ciry Enginecr <br />Issued <br />r' <br />l i ��_ <br />Inspection By_ ,{ , �,*-�==c�- — _ _ <br />Datelnspected q 6 <br />^^ n�n <br />NO. ,� � <br />