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everett <br />IFJ <br />City of Everett <br />Engineering DepartmPnt <br />Sewer Application and Permit <br />NO. DATE <br />Service Address, — <br />Billing Address_— — <br />City, State, Zip <br />Owner (Mortgagor) -- <br />Billing Name <br />Connection By — <br />Address_--.— - — <br />Phone — -- <br />DESCRIPTION: <br />Lot <br />Block_ <br />Division or Addition <br />SEE SKETCH ATTACHED <br />Utility Account No.. <br />Connection Permit F <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 City Engineer <br />Issued <br />Inspection BY <br />Date Inspected <br />No. 21.331 <br />