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everett <br />� <br />City of Everett <br />Engineering Uepartment <br />. - ; . �� - <br />- ' - ^ � . <br />Sewer Applicdtion and Permit <br />NO. �� _ � `�� �� DATE <br />Service Address <br />Elilling Address <br />C;itY, State, 2iF — <br />Owner (Mortgagor) <br />Billing Name _ <br />Connection By <br />Phone <br />DESCRIPIION: <br />Lot _ <br />Block <br />Division or Add <br />Type Permit: <br />Utility Account No. <br />Ccnnection Permit f <br />Connection Fee_ <br />Total Fee <br />Sewer District <br />Monthly Sewer Service <br />_ PAonthly Sewer Consir. <br />— Trunk <br />SEESKETCH ATTACHED <br />Abutting Lot Line <br />N, S, E, W <br />Approved <br />Cuy Enqwer.t <br />I s,ued <br />Inspection By � .� ����--� <br />Date Inspected �� Z�%� <br />N0. . <br />� .. ., <br />ft. <br />