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everen <br />� <br />City of Everett <br />Engineerinp Department <br />�ewer Application and Permit <br />NO. n �- ::� .i �'�; DATE <br />Service Address <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Name <br />Connection By <br />Address <br />DESCRIPTION: <br />Lot <br />Block <br />Division or Addition <br />Type Permit: <br />Utility Account No. <br />Connection Permit Fee <br />Connection <br />Total Fee <br />Signed <br />Customer <br />SEESKETCH ATTACHED <br />!�:��. ����� .. <br />Sewer District <br />Monthly 5ewer Service <br />Monthly Sewer Cor.str. <br />Trunk <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />Approved By <br />Ciry EnBineer <br />Issued By <br />Inspection By.�S��✓� <br />Date Inspected �� � � � <br />N0. �_�_`� )_`�. <br />