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everett <br />� <br />City of Everett <br />Engineering Uepartment <br />Sewer �pplieation and Perrv�it <br />N0. _ DATE <br />Service Address <br />Billing Address � <br />City, State, Zip__ <br />Owner �Mortgagor)__ <br />Billing Name <br />Connection By <br />Phone <br />DE�:RIPTION: <br />Lot <br />Block <br />Division or ,4ddition <br />-r....., o,.....i�• <br />/�o � `�� -� <br />/f- - /�J - 2 �' - 5-- <br />� - � - � � <br />/Z�� <br />Utility Account No. <br />Connection Permit I <br />Connection Fee_ <br />Total Fee <br />Sign <br />Sewer Uisvict <br />Monthly Sewer Service, <br />Monthly Sewer Constr. <br />SEE SKETCH ATTACHED <br />Abutting Lot Line <br />N,S,E,W <br />Approved By_ <br />Ciry EnB�neer <br />Issued <br />I nspection <br />Datelnspe <br />