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D <br />City of Everett <br />Engineering Department <br />Sewer Application and Permit <br />NO. DATE <br />Service Address <br />Billing Address --- <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Name <br />Connection By ---- <br />Address _— <br />Phone <br />DESCRIPTION: <br />Lot <br />Block <br />Division or Addition <br />Type Permit: <br />Utility Account No <br />Connection Permit <br />Connection Fee_ <br />Total Fee <br />Sign <br />Remarks: V '' n 0 --r=_ zt: <br />SEE SKETCH ATTACHED <br />i <br />I�-1 -- - z 13 - <br />iff <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 Engineer <br />Issued <br />Inspection By <br />Date Inspect ad <br />NO. <br />