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� �� lj� _ <br />everett " f " � <br />� . G, <br />City of Everett <br />Engineering Oepartment <br />Sewer App�ication and Perrnit <br />NO. DATE <br />Service Address <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Name <br />Connection By — <br />DESCRIPTION: <br />Lot <br />Block <br />Division or Add <br />i'" �, _ ,,i' � <br />Utility Account Nc <br />Connection Permit <br />Connection Fee_ <br />Total Fee <br />Signed <br />- .--. �-s <br />Sewe� District___ <br />Monthly Sewer Service—_ <br />Monthly Sewer Constr <br />Trunk <br />Laterai <br />Abutting Lot Line <br />N, S, E, W_ ft. <br />Approved By_ <br />Ciry Enpineer <br />issued B <br />Inspection B <br />Datelnspect <br />0 <br />SEE SKETCH ATTACHED NO ��� � <br />I� <br />