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everetl �� rj 0 <br />City of Everett (1 <br />Engineering Department <br />n <br />Sewer Application and Permit <br />NO. <br />Service Address_ <br />Billing Address_ <br />City, State, Zip_ <br />Owner (Morgag <br />Billing Name_ <br />Connection By_ <br />Address__ <br />Phone --- <br />DESCRIPTION: <br />Lot <br />Block _ <br />Division or Add <br />DATE <br />Utility Account No <br />Connection Permit <br />Connection Fee_ <br />Total Fee <br />Signed._ <br />Cugartrer <br />Sewer District <br />Monthly Sewer Service, <br />Monthly Sewer Constr. <br />Trunk <br />Type Permit: _ <br />Lateral <br />Remarks: AS fE� Sf�T _ Abutting Lot Line <br />N, S, E, W <br />SEE SKETCH ATTACHED <br />Approved By <br />City Engineer <br />Issued <br />IInspection By_ <br />Date Inspected_ /L /751 <br />No. 21162 <br />