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evere" <br />e <br />City of Everett <br />Engineering Department <br />Sewer Application and Permit <br />NO. <br />DATE <br />Service Address ---- <br />Billing Address <br />City, State, Zip__ _.--_-. <br />Owner (Mortgagor) — ----- <br />Billing Name <br />Connection By --— <br />Phone <br />DESCRIPTION: <br />Lot <br />Block <br />Division or Addit <br />Type Permit: <br />a — <br />SEE SKETCH ATTACHED <br />Utility Account No <br />Connection Permit <br />Connection Fee_ <br />Total Fee <br />Signed <br />Customer <br />Sewer District — <br />Monthly Sewer Service. <br />Monthly Sewer Constr. <br />Abutting Lot Line <br />N, S, E, W <br />Approved By <br />City Engineer <br />Issued By_ <br />Inspection By <br />Date Inspected_ 2- <br />NO. 3 0 <br />