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everett - <br />e <br />City of Everett <br />Engineering Department <br />Sewer Application and Permit <br />N0. i_ !. ' , DATE <br />Service Address <br />Billin� Address <br />Ci!y, State, Zip <br />Owner {Mortgagor) <br />Billing Name <br />Connection By <br />Phone <br />DESCRIPiIOP' <br />Lot <br />Biock <br />Division or Addition <br />Util�ty Account Nc <br />Conr.ecticn "rermit <br />Connection Fee_ <br />Total Fee <br />E <br />Remarks: <br />e <br />SEE SKETCH ATTACHED <br />,,�__ Z q._ <br />`_ <br />�� /J ^ i <br />_ P ��_ . <br />Cusmmer <br />Sewer District <br />Monthly Sewer Service _ <br />Monthly Sewer Constr. <br />Latera <br />Abutting Loi Line <br />N, S, E, W. <br />Approved By <br />Ciry Engineer <br />I ssu ed <br />Inspection By � <br />Datelnspected�� <br />NO. ��'���' <br />r _ � � <br />