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everett <br />e <br />City of Everett <br />Engineering Oepartment <br />r� <br />Sewer Application and permit°- <br />N0. DATE <br />Service Address <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Name -- <br />Connection Bv <br />Phone <br />DESCRIPTION: <br />Block <br />Division or Addition. <br />Type Permit: <br />Utility Account No._ <br />Connection Permit Fe.e <br />Connection Fee__ <br />Total Fee _ <br />Signed _ <br />Cusmrtrer <br />S�ESKETCH ATTACHED <br />SeN�er District__ <br />Monthty Sewer Service _ <br />Monthly Sewer Constr. <br />Trunk <br />Abutting lot Line <br />N, S, E, W <br />Approved By <br />City Enqinecr <br />Issued <br />Inspection By �/'—��+�'�'� r <br />Date I nspected_ i �'��� <br />N0. . - <br />