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_., <br />e <br />City of Everett <br />Engineering Department <br />Sewer Applicat�on and Permit <br />N0. , _ . , DATE <br />Service Address <br />Billiny Address <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Name <br />Cc�nection Bv_ <br />DESCRIPTION: <br />Lot <br />Block <br />Division or Additinn <br />Type Permit: <br />Utility Account No._ <br />Connection Permit Fee <br />Connection Fee <br />Total Fee <br />Signed <br />SEESKFTCH ATTACHED <br />Sewer District <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Trunk <br />La±.eral <br />Abutting Lot Line <br />N, S, E, W. <br />Approved By <br />Ciry Engineer <br />Issued <br />Inspection By <br />)ate Inspected �. — II— (� <br />�0. <br />