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everett <br />e <br />City of Everett <br />Engineering Department <br />Sewer Application pnc! permif <br />NO. � � � <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 />Type Permit: <br />DATE <br />Utility Account No.. <br />Connection Permit F <br />Corniection Fee_ <br />Total Fee <br />Signed_ <br />SEESKETCH ATTACHED <br />Sewer District <br />Month;y Sewe; Service <br />Monthly Sewer Constr. <br />Abutting Lot Line <br />N, S, E, W_ <br />4pproved By � <br />City Engineer <br />ssued <br />-.����-,� <br />ispection By ���.,!/�u <br />ate I nspected /� / ��j {, <br />NO. ^'j '_, <br />