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everett <br />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 />Phone <br />DESCRIPTION: <br />Lot <br />Block <br />Division or Addition <br />Type Permit: <br />DATE <br />Remarks: As AA Sea <br />SEE SKETCH ATTACHED <br />Utility Account No.. <br />Connection Permit F <br />Connection Fee_ <br />Total Fee <br />Signed <br />Customer <br />Sewer District <br />Monthly Sewer Service _ <br />Monthly Sewer Constr. <br />Lateral <br />Abutting Loy Line <br />N, S, E. W, <br />Approved By <br />City Enpinear <br />Issued <br />Inspection By <br />Date Inspected S� _ <br />NO. <br />I <br />