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�everatt <br />.� <br />City of Everett <br />Engineering Department <br />Sewer �pp(ication and Permit <br />N0. �_ .' _ DATE <br />Service Address <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor) <br />f2illing Name <br />Connection By <br />Phone <br />DESCRIPTION: <br />Lot <br />Block__ <br />Divisior. or /�dd <br />Type Permit: <br />Utility Account No._ <br />Connection Permit Fee <br />Connection Fee <br />Total Fee <br />Signed _ _ <br />Customm <br />7 <br />SEESKETCH ATTACHED <br />Sewer District <br />Monthly Sewer:ervice. <br />Monthly Sewer Constr. <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />Approv d By <br />Ciry Engineer <br />Issued <br />Inspection By <br />Datelnspected —� " <br />N0. r��� -';�,-; <br />