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everett <br />e <br />City of Everett <br />Engineering Department <br />Sewer A�,pplication and Permit <br />N0. ," ' . <br />Service Addre;s_ <br />Billing 4ddress <br />City, State, Zip_ <br />Owner (Mortgagor�_ <br />Billing Name <br />Connection By_ <br />DESCRIPTION: <br />Lot <br />Block <br />Division or Addition <br />Type Permit: <br />DATE <br />Utility Account N� <br />Connection Permit <br />Connection Fee_ <br />Total Fee_ <br />Signed_ <br />SEE SKETCH ATTACHED <br />Sewer District <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Trunk <br />Abutting Lot Line <br />N, S, E, W. <br />Approved By <br />Ciry Fngineer <br />Issued <br />Inspection By �- � L , �. ___, <br />)ate Inspected _��G�', _ _ <br />N �. <br />