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` everen <br />I �-� <br />�'� <br />City of Everett <br />Engineering Oepartment <br />��` � �`_ �.� <br />Sewer �4pplicatiQn and Permit <br />N0. ' ! DATE <br />Service Address_ <br />Billing Address_ <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Name <br />Connection Bv_ <br />Phone <br />DESCFIPTION: <br />Lot <br />Block <br />Division or Addition. <br />Utility Account Nc <br />Connection Permit <br />Connection <br />Total Fee_ <br />Signed_ <br />Customer <br />SEE SICETCH ATTACHED <br />Sewer District <br />Monthly Sewer Service. <br />Monthly Sewer Constr. <br />Abutting Lot Line <br />N, S, E, W <br />Approved B <br />I ssued <br />Inspection <br />Datelnspe <br />City Enpineer <br />NO � � -. ,7 <br />