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ev�iilt <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 />DESCRIPTION: <br />Lot <br />Block <br />Division or Addition <br />Type Permit: <br />SEE SKETCH ATTACHED <br />i. <br />Utility Account Nc <br />Connection Permit <br />Connection Fee_ <br />Total Fee <br />Signed. <br />Cmtomar <br />Sewer District <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />Approved By <br />City Enpinea <br />Issued <br />Inspection By Al � — <br />Date Inspected_T� 9G <br />NO. ?1334 <br />