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everett <br />e <br />City of Everett <br />Engineering Oepartment <br />Sewer A►pplication and Permit <br />N0. ;: ' ' DATE _ <br />.- <br />Service Address ����/�-- <br />Billing Address <br />City, State, Zip � <br />Owner (Mortgagor) <br />Billing Name_ <br />Connection By._ <br />Utility Account Nc <br />Connection Permit <br />Connecticn Fee_ <br />Total Fee <br />Signed <br />. . �, _ _ . <br />�. <br />Phone_ <br />DESCRIPTiON: / Sewer District <br />Lut �y <br />Monthly Ser:er Service. <br />Block�.�— � <br />Division or Addition %�����- -S �/e� Monthly Sewer Constr. <br />SEESKETCH ATTACHED <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />Approved By <br />Ciry Engineer <br />ISSUBd <br />Inspection By <br />Date Inspected <br />NO. <br />