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City of Everett <br />Engineering Department <br />Sewer Application and Permit <br />NO. <br />Service Address -- <br />Billing Address <br />City, State, Zip _ <br />Owner (Mortgagor) <br />Billing Name_ <br />Connection By -- <br />Address <br />DESCPIPTION: <br />Lot <br />Block_ <br />Division or Add <br />Type Permit: <br />DATE <br />SEE SKETCH ATTACHED <br />P--�s� <br />v> <br />Utility Account No <br />Connection Permit F <br />Connection <br />Total <br />Signed_ <br />Customer <br />Sewer D <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Lateral <br />Abutting Lot Line <br />N, S, E, W ft. <br />Approved By <br />City Engineer <br />Issued <br />Inspection By <br />Dateinspected <br />N0. 21387 <br />