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everett <br />e <br />City of Everett <br />Engineering Department <br />Sewer Application and Permit <br />N0. '. DATE <br />Service Address_ <br />Billing Address_ <br />City, State, Zip_ <br />Owner �Mortgago <br />Billing Name_ <br />Connection By_ <br />Address_ <br />DESCRIPTION: <br />Lot <br />Block <br />Division or Add <br />Type Permit: <br />Remarks: <br />Utility Account No. <br />Connection Permit I <br />Connection Fee_ <br />Total Fee <br />Signed___— <br />c��,;��„�•, <br />Sewer District <br />Monthly Sewer Service_ <br />Monthly Sewer Constr. <br />SEESKETCH ATTACHED <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />Approved By <br />City Engineer <br />Issued <br />Inspection <br />Datelnsoe <br />N0. <br />