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everett <br />.� <br />City of Everett <br />Engineenaa fl�partment <br />; �� �, �,,- ... - : <br />:`.- , �, 01 _ <br />� - . r ��- <br />Sewer Application and Permit <br />NO. ._I -- <br />Service Address_ <br />Billing Address_ <br />City, State, Zip_ <br />Owner (Mortgagor)_ <br />Billing Name <br />Connection By� <br />Address <br />Phone — <br />DESCRIPTION: <br />Lot <br />Block <br />Division or Addition <br />Type Permit: <br />Remarks: <br />DATE <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 />Lateral <br />' ' Abutting Lot Line <br />' N� S, E, W ft <br />-r � , <br />`. <br />8 <br />SEESKETCH ATTACHED <br />Approved <br />Issued 8Y. <br />Enpineer <br />Inspection By <br />�� �j.��� ss�t2� <br />Date InspecYed C—/ G' 7� — <br />NO. <br />