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everett <br />e <br />City of Everett <br />Engineering Department <br />Sewer Application and Permit <br />N0. . DATE <br />Service Address �'��� �'�p" �—�"6�-�— <br />Billing Address <br />City, State, Zip <br />Owner IMortgagor) <br />Billing Name <br />Connection By <br />Phone <br />DESCRIPTION: <br />Lot _,1,? -_ <br />Block � <br />Division or Addition <br />Utility Account No._ <br />Connection Permit Fee <br />Connection Fee <br />Total Fee <br />Signed <br />Sewer District <br />Monthly Sewer Service. <br />Monthiy Sewer Constr. <br />Lateral <br />Abutting Lot Line <br />N, S, E, W. <br />Approved By. <br />Ciry Engineer <br />I ssu ed <br />Inspection By �����`""�"� — <br />Date Inspected �� �Z��� <br />,�� <br />,. <br />NO. ._ �•�,; <br />