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evereR <br />e <br />City of Everett <br />Engineering Department <br />Sewer Application and Permit <br />NO. <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 />Tvne Permit: <br />DATE <br />SEE SKETCH ATTACHED <br />INSPECTION <br />Utility Account No <br />Connection Permit <br />Connection Fee_ <br />Total Fee___ <br />Signed <br />Sewer District <br />Monthly Sewer Service. <br />Monthly Sewer Constr. <br />Trunk <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />Approved By <br />City Engineer <br />Issued <br />ZIP - <br />Inspection Byy <br />Date Inspected led) �G <br />No. 21496 <br />