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evereri <br />� <br />City of Everett <br />Engineering Department <br />Sewer Application and Permit <br />NQ _. ' DATE <br />Service Address <br />Billing Address <br />City, State, Zip <br />Owner (Mortga <br />Billing Name_ <br />Connectian By. <br />DESCRIPTION: <br />Lot <br />Block <br />Division or Addition <br />Tvpe Permit: <br />.1T— '' _ __�� - '� <br />l ; <br />Utility Account No.. <br />Connection Permit F <br />Connection Fee_ <br />Total Fee <br />SEESKETCH ATTACHED <br />Sewer District___ <br />Monthly Sewer Service <br />Monthly Sewer Constr <br />Abutting Lat Line <br />N, S, E, W <br />Approved By_ <br />Ciry EnBineer <br />Issued <br />Inspection <br />Datelnsoe <br />N0. ,� �i .. � i . <br />