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everett <br />e <br />City of Everett <br />Engineering Department <br />Sewer Application and Permit <br />NO. �_ . DATE <br />Service Address <br />Billing Address <br />City, State, Zip_ <br />Owner (Mortgagor) <br />Billing Name <br />Connection By <br />Phone <br />DESCRIPTION: <br />Lot <br />Block <br />Division or Addition <br />Type Permit: <br />Utility Account Nc <br />Connection Permit <br />Connection Fee_ <br />Total Fee__ <br />Signed <br />Cusromer <br />SEESKETCH ATTACHED <br />Sewer District <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Abutting Lot Line <br />N, S, E, W, <br />Approved By <br />Ciry Engineer <br />Issued <br />Inspection <br />�ate Insoe� <br />NO. <br />