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�� _ � <br />� <br />.;ity of Everett <br />Engineering Department <br />Sewer Application and Permit <br />NO. .�U92Q �ATE <br />Service Address <br />Billing Address <br />City, State, Zip__ <br />Owner (Mortgagor) <br />Billing Name <br />Connection By <br />Address _ <br />Phone_ <br />DESCRIPTIt�N: <br />Lot _ <br />Block <br />Division or Addition <br />Type Permit: <br />Utility Account No._ <br />Connection Permit Fee_ <br />Connection Fee <br />Total Fee <br />Signed ___ <br />Cusicmer <br />SEESKETCH ATTACHED <br />�,� <br />Sewer Distrir,t <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Trunk <br />Abutting Lot Line <br />N, S, E, W <br />Approved <br />� SSII Cd <br />Inspection <br />Date Insne <br />City Enginecr <br />N0. �j�,;�,-, <br />t. <br />