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everett <br />� <br />City of Everett <br />Engineering Department <br />. s�� �` ,� �'�'fm'.. <br />Sewer Application and Permit <br />tv o. ; +. � � ; � ; <br />Service Address _ <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor) _ <br />Billing Name <br />Connectio� By ' <br />Address _— <br />Phone <br />DESCRIPTION: <br />Lot <br />Block <br />Division or Addition <br />Tvoe Permit: <br />DATE <br />� <br />Utility Account No. <br />Connection Permit I <br />Connection Fee_ <br />Total Fee <br />Si9ned <br />Sewer District <br />Monthly Sewer Service. <br />Monthly Sewer Constr. <br />SEE SKETCH ATTACHED <br />Lateral,_ <br />Abutting Lot Line <br />N,S,E,W <br />Approved BY <br />City Engineer <br />Issued 6 <br />Inspection By <br />'�� � �� <br />Date I nspected � � � /�> �- <br />N 0. :' _'. ' � `l r <br />