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everett <br />� <br />(,ity of Everett <br />Engineering Department <br />�ev�rer .�4pplizcstion a�d P'�rmit <br />NO. - DATE <br />�� _ �,�� � UJ <br />Service Address "'�-?� > <br />Billing Address <br />City, State, Zip — <br />pwner (Mortg.gor) <br />Billing Name <br />Connection By <br />•.� <br />Phone <br />DESCRIPTION: <br />Lot =�— <br />Block <br />Division or Addition <br />Utility Account Nu._— <br />Connection Permit Fee <br />Connection Fee <br />Total Fee�-- <br />Signed Custom <br />Sewer District <br />Monthly Sewer Service. <br />Monthly Sewer Constr. <br />Trunk <br />Lateral_ <br />abutting Lot Line <br />N, S, E, W_ <br />Approved By <br />City En9ine�r <br />Issued <br />Inspection By ^�� �"�� ��� <br />Date Inspected� � � <br />NO. <br />