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W <br />City of Everett <br />Engineering Department <br />Sewer Application and Permit <br />NO. DATE <br />Service Address <br />Billing Address _ <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Name <br />Connection By <br />Address --_ <br />DESCRIPTION: <br />Lot <br />Block <br />Division or Add <br />Type Permit: <br />a <br />SEE SKETCH ATTACHED <br />L- <br />Utility Account No.. <br />Connection Permit F <br />Connection Fee_ <br />Total Fee <br />__ Signed <br />Customer <br />Sewer District <br />Monthly Sewer Service. <br />Monthly Sewer Constr. <br />Trunk <br />Lateral_ <br />Abutting Lot Line <br />N, S, E, W_ <br />Approved by <br />City Eng,neer <br />I ssu ed <br />Inspection By__ <br />Date Inspected_ _ <br />No. 21161 <br />a <br />