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everett <br />� <br />City of Everett <br />Engineering Uepartment <br />Sewer Ap�aliCa�ia�� and Permit <br />,-, _ <br />N0. �: .� : <br />� Service Address <br />i <br />� Billing Address <br />I� <br />( City, State, Zip <br />I' Owner (Mortgagur) <br />� Billing Name <br />Connectio�i Bv__ <br />� <br />DESCRIPTION: <br />Lot <br />Block <br />DiviSion Or Addition <br />Type Permit: <br />DATE <br />Utility Account No. <br />Connection Permit I <br />Connection Fee_ <br />Total Fee_ <br />Signed <br />Customer <br />SEE SKETCH ATTACHED <br />Sewer District <br />Monthly Sewer Service <br />I�lonthiy Sewer Constr. <br />Trunk <br />Lateral <br />Abutting Lot Line <br />N, S, E, W_ <br />Approved By <br />City Engineer <br />Iseued <br />,�/ " -,� — <br />Inspection By,�"��- <br />)ate Inspected___ / � Lc �7•,— <br />NO. n �' ' � <br />