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City of Everett <br />r <br />Engineering Department <br />Sewer Application and Permit <br />NO. 20770 DATE <br />Service Address <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Name <br />Connection By <br />Phone <br />DESCRIPTION: <br />Lot <br />Division or Addition <br />Tvoe Permit: _ <br />SEE SKETCH ATTACHED <br />Utility Account No, <br />Connection Permit I <br />Connection Fee_ <br />total Fee <br />Signed <br />Customer <br />Sewer District <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Trunk <br />0 <br />Abutting Lot Line <br />N, Sft, <br />Approved By <br />City Engineer <br />Issued <br />Inspection By��0y <br />Da'e Inspected__AcG <br />NO. 20770 <br />