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everett <br />e <br />City of Everett <br />Engineerinp Department <br />Sewer Application and Permit <br />r,o. 2i55i 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 />81ock <br />p�vision or Addition <br />Tvpe Perrt�it: <br />Utility Account No. <br />Connoction Permit I <br />Connection Fee_ <br />Total Fee - <br />Sign <br />SEE SKETCH ATTACHED <br />��.S�,prl�l li:�. <br />Sewer Distrlct <br />M��thly Sr.wer Service. <br />Monthly Sewer Constr. <br />Lateral <br />Abutting Lot Line <br />N, S. E, W <br />Appraved By <br />City EnBineer <br />ISSUEd <br />I nspection <br />Datelnspe <br />NO. ' .I_ j � �_ <br />