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everett <br />e <br />City of Everett <br />Engineering Department <br />i/� : r _ ' <br />��:. .. � — - <br />Sewer Application and Permit <br />NO. <br />Service Address_ <br />Billing Address_ <br />City, State, Zip_ <br />Owner �Mortgagoi <br />8illing Name_ <br />Connection By_ <br />, DATE <br />Phone <br />DESCRIPTION: <br />Lot <br />81ock <br />Division or Addition <br />T....a Dn��mit• <br />Uti!ity Account No.. <br />Connection Permit F <br />Connec:ion Fee_ <br />Total Fee <br />Signed_ — <br />c�s�om�� <br />Sewer Distnct <br />Monthly Sewer Service. <br />Monthly Sewer Constr. <br />0 <br />SEESKETCH ATTACHED <br />Abutting Lot Line <br />N,S,E,W <br />Approved By <br />Ctry Engineer <br />I SSU Cd <br />��� �rT�� <br />Inspection B•,_ '"�—tti`�"'"�•�-- <br />/ �-� <br />Date �nspected 5 —_� — <br />NO. <br />