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everett <br />e <br />City of Everett <br />Engineerinp Depertment <br />; Sewer Application and Permit <br />N0. C_ _I,_ ;) �� � DATE <br />Service Address <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Name <br />Connection By <br />DESCRIPTION: <br />Lot <br />Block <br />Division or Addition <br />Tvoe Permit: <br />Utility Account No._ <br />Connection Permit F <br />Connection Fee_ <br />Total Fee <br />Signed <br />cu:tortrer <br />Sewer District <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Trunk <br />SEE SKETCH ATTACHED <br />If::;l'�Cl�liliJ <br />Abutting Lot Line <br />N, S, E, W. <br />Approved By ' <br />City Enpineer <br />ISSUEd <br />Inspection By . , <br />Datelnspected �' ' " <br />N0. �15J�. <br />