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everett <br />e <br />City of Everett <br />Engineering Department <br />�. � �I �>. . <br />-: 20 —2. �, <br />. -- �S �- • : <br />"o' i" <br />�•r• (I `� <br />Sewer Application and Permit <br />NO. r' J. � i'. DATE ' <br />Service Address <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor)_ <br />Billing Name <br />Connection Bv <br />DESCRIPTION: <br />Lot <br />Block <br />Division or Addition. <br />Type Permit: <br />Utility Account N� <br />Connection Permit <br />Connection Fee_ <br />Total Fee <br />Signed <br />cusmmer <br />SEESKETCH ATTACHED <br />Sewer District <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />Approved By <br />Ciry Enpineer <br />Issued B <br />Inspectian By C'. ''_, /I <br />�ate lnspected - ';: 'G' <br />N0. <br />� <br />