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eW <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Permit <br />NO. DATE <br />Service Address__ <br />Biding Address <br />City, State, Zip_ <br />Owner (Mortgagor) <br />Billing <br />Connection <br />Pho <br />DESCRIPTION: <br />Lot <br />Plat _ <br />Unplatted Descr <br />Type Permit: C <br />Block <br />SEE SKETCH AT -,ACHED <br />CHART NO. V l <br />Utility Account No.. <br />Permit Fee_— 36) <br />Connection Charge(s) <br />Total Fee <br />Signed_ <br />C imomcr <br />Sewer <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Abutting Lot Line <br />N, S, E, w <br />Approved By <br />City Engineer <br />Issued By <br />nspection By—(C _ <br />)ate Inspected <br />N0. <br />