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everett <br />e <br />City of Everett <br />Engineering Department �,n <br />f. <br />Sewer Application and Permit <br />N0. �- __ DATE <br />Service Address <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagur) <br />Billing Name <br />Connection Bv <br />DESCRIPTION: <br />Lot <br />Block _ <br />Division or Addition <br />Type Permit: <br />: -z�- �� <br />_ ��� �, <br />�.,: <br />Utility Account No.. <br />Connection Permit F <br />Connection Fee_ <br />Totai Fee <br />Signed_ <br />Cusiomer <br />Sewer District <br />Monthly Sewer Service. <br />Monthly Sewer Constr. <br />Lateral <br />Abutting Lot Line <br />N, S, E, W. <br />Approved B <br />I ssued <br />Inspection <br />Datelnsoe <br />Ciry Engineer <br />a <br />SE[ SKETCH ATTACHED N0. <br />