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evere� <br />City of Everett <br />Engineering Department <br />S�wrer Applicatior� And Perrnit <br />� <br />DATE <br />Service Address <br />Billina Address_�_ <br />City, State, 2ip�_ <br />�_ <br />Owner (Mortgagor) <br />Billiiig Name_ <br />Connectiun <br />Phone <br />DESCRIPTION: <br />Lot__� <br />Block�__ <br />Division or Addition <br />Type Permit: <br />Utility Account No., <br />Connection Perrr.it F <br />Connection <br />Total Fee <br />E <br />SEE SI<ETCH ATTACHED <br />� <br />customti <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 />Ciry cnginecr <br />ssued <br />ispection By ��______ <br />3te Inspectedl ��/ 1��G <br />� ---- <br />NO. <br />