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everett <br />e <br />City of Everett <br />Engineering Department <br />„�c ; ,�C� i � <br />5 , rz-�� <br />Z_ ���-7�'i— Sf <br />/3 c°il � � <br />Sewer Application and Per�mit <br />NO. � 1 [� � � DATE <br />Service Address <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Name <br />Connection By <br />Phone <br />DESCRIPTION: <br />Block <br />Division or Addition <br />Type Permit: <br />Utility Account No <br />Connection Permit <br />Connection Fee_ <br />Total Fee <br />Signed <br />Sewer District <br />Monthly Sewer Service. <br />Monthly Sewer Constr. <br />Trunk <br />Lateral <br />SEESKETCH ATTACHED <br />outting Lot Line <br />N, S, E, W <br />�proved <br />;ued <br />spection <br />ite I nspe� <br />Ciry Engincer <br />N0. I? <br />