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everen <br />� <br />City of Everett <br />Engineerir�{ Department <br />Sewer Application and Permit <br />NO. ,�. . . <br />Service Address._ <br />DATE <br />Billing ArJdress _ <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 No. _ <br />Connection Permit Fee <br />Connection Fee <br />Total Fee <br />E <br />Sewer District <br />Monthly Sewer Service <br />f�9onihly Sewer Constr. <br />Abuttinn Lot Line <br />iV, S, E, !'J. <br />Approved B•+ <br />Ciry Engineer <br />Issued B <br />Inspection By���u-l�� <br />/ i <br />Date Inspected (v 7% <br />N 0. �! I s <br />