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evere� <br />� <br />City of Everett <br />Engineering Department <br />Sewer Ap�alication and Perrr�it <br />• �' �-' ' '- DATE <br />N0. C. 1 �> -: �-- <br />Service Address�!�—� `� v <br />Billing Address <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 />Utility Account No. <br />Connection Permit I <br />Connection Fee_. <br />Total Fee <br />Signed _ <br />Customer <br />Sewer <br />Monthly Sewer <br />Monthly Sewer Constr. <br />SEE SKETCH ATTACHED <br />I� ISP-{ ii; . <br />Abutting Lot Line <br />N, S, E, W, <br />Appioved kiy <br />City Engineer <br />I SSU P;1 <br />Inspection <br />Date I <br />� <br />�.� � <br />N0. _ _ �, , <br />