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evereR <br />� <br />City of Everett <br />Engineerinp Oep�rtmant <br />Sewer Application and Permit <br />N0. � .� � �� �� DATE <br />Service Address <br />Billing Address — <br />City, State, Zip <br />Owner (Mortgagor) <br />8illing (Vame <br />Connection By <br />Phone — <br />DESCRIPTI ON: <br />Block <br />Division or Addition <br />Tvnn Parmit� <br />1 <br />Utility Account No. <br />Connection Permit I <br />Connection Fee_ <br />Total Fee <br />Signed <br />Sewer District___ <br />Monthly Sewer Service. <br />Monthly Sewer Constr. <br />e <br />SEESKETCH ATTACHED <br />Ahutting Lot Line <br />N, S, E, W. <br />Approved By - <br />City Engineer <br />Issued <br />Inspection By �— � � --l� <br />Date Inspected_� — �'�— ^ y� <br />N0. � <br />