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everett- <br />e��� <br />City of Everett <br />Engineering Uepartment <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 />Cunnection By _ <br />Address <br />Phone <br />DESCRIPTION: <br />Lot <br />[31ock_ <br />Division or Addition <br />Utility Account Nc <br />Connection Permit <br />Connection F <br />Total Fee_ <br />Signed <br />Customer <br />SEESKETCH ATTACHED <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 />Ciry EnBineer <br />I SSUe(I <br />Inspection By <br />Datelnspected <br />N0. '?� `�-� <br />