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everert <br /> e � <br /> City of Everett <br /> Engineering Department <br /> Sewer Application and Permit <br /> N0. � ' ._ � � , DATE <br /> Service Address_��_ ���� C Utility Account No. <br /> Billing Address Connection Permit Fee — <br /> City,State, 2ip Connection Fee <br /> Owner (Mortgagor) Total Fee — <br /> Billing Name <br /> Connection By <br /> Address Signed_ <br /> Customer <br /> Phone <br /> DESCRIPTION: Sewer District — <br /> Lot <br /> Monthly Sewer Service <br /> Block <br /> Division or Addition ' Monthiy Sewer Constr. <br /> Trunk <br /> Type Permit: <br /> Lateral <br /> Remarks: <br /> Abutting Lot Line <br /> /S _ N, S, E, W ft. <br /> Appraved By <br /> City Engineer <br /> Issued By <br /> Inspection By � <br /> Date I nspected <br /> e <br /> SEE SKETCH ATTACHED Np• � '' � i-� � <br /> i . .r _ � <br />