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everCd <br />e <br />City of Everett <br />Engineering Uepertment <br />Sewer Application anc� Permit <br />NO. % _ DATE <br />Service Address ������ �"�` n—� <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Name <br />Connection By <br />Phone <br />DESCRIPTION: <br />Lot <br />Block_ <br />Division or Addition <br />Utility Account No. <br />Connection Permit I <br />Connection Fee._ <br />Total Fee <br />Signed Customer <br />Sewer District <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Trunk <br />Lateral <br />SEESKETCH ATTACHED <br />4butting �ot Line <br />N, S, E, N' <br />qpproved BY ���� �ngineer <br />Issued <br />Inspection By _� <br />Date Inspected <br />N0. <br />