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evereft <br />� <br />City of Everett <br />Engineering Department <br />Sewer Applicatinn and Permit <br />NO. _ DATE <br />Service Address <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor�__ <br />Billing Name <br />Connection By — <br />Address _ — <br />Phone_ <br />DESCRIPTION: <br />Lot <br />Block <br />Division or Addition <br />Utility Account No. <br />Connection Permit I <br />Connection Fee_ <br />Total Fee <br />, �. i — '" <br />Siyned <br />Customer <br />Sewer Distnct <br />Monthly Sewer Service. <br />Monthly Sewer Constr. <br />0 <br />SEE SKETCH ATTACHED <br />Abutting Lot Line <br />N, S, E, W— <br />Approved By <br />Ciry Engineer <br />Issued <br />� / <br />Inspection By—t��� ��'—d �'^— <br />Date Inspected 7 ,'� �% <br />NO. � ' <br />