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� everett <br />� <br />City of Everett <br />Engineering Department <br />Sewer Application and Permit <br />N0. �- � <br />DATE <br />Service Address Utility Account No. <br />Billi�g Address <br />Connection Permit Fee <br />City, State, Zip <br />Connection Fee <br />Owner (Mortgagor) Total Fee <br />Billing Name — <br />Connection By — <br />Signed <br />Addf055 Cusmmer <br />Phone <br />DESCRIPTION: Sewer District <br />Lot Monthly Sewer Service <br />Block <br />Division or Addition Monthly Sewer Constr. <br />Trunk <br />Type Permit: <br />—� Lateral_ <br />0 <br />SEE SKETCH ATTACHED <br />Abutting Lot Line <br />N, S, E, W <br />Approved By — <br />Ciry Engm�er <br />ISSUBd <br />Inspection By��/ � ���� "� <br />Date lnspectad �� '� 7� <br />NO. n � ,1 r ;� <br />