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everett <br />� <br />City of Everett <br />Engineering Department <br />.�-,. �i� '�' .ov-. <br />i <br />Sewer Application and Permit <br />N0. DATE �_ <br />Service Address Utility Account No._. <br />Billing Address Connection Permit Fe <br />City, State, Zip Connection Fee_ <br />Owner (Mortgagor) Total Fee <br />Billing Name <br />Connection By ' <br />Phone <br />DESCRIPTION: <br />Lot <br />Block <br />Division or Addition <br />Tvoe Permit: <br />Signed_ <br />Customer <br />Sewer District <br />Monthly Sewer Service. <br />Monthly Sewer Constr. <br />SEE SKETCI-i ATTACHED <br />Lateral_ <br />Abutting Lot Line <br />N, S, E, W <br />Approved By__ <br />City Engineer <br />Issued <br />Inspection <br />Datelnspe <br />No. `?1.2( _. <br />