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0 <br />everett <br />City of Everett <br />Engineering Department <br />Sewer Application and Permit <br />NO. <br />Service Addres<. <br />Billing Address <br />City, State, Zip <br />Owner (Mortga <br />Billing Name_ <br />Connection By - <br />DESCRIPTION: <br />Lot <br />Block <br />Division or Addition <br />Type Permit: <br />DATE _ <br />SEE SKETCH ATTACHED <br />_ Utility Account No. <br />Connection Permit Fee <br />_ Connection Fee_ <br />Total Fee <br />Signed <br />Cunom:r <br />Sewer District <br />Monthly Sewer Service <br />Monthly Sewer Constr <br />Trunk <br />Abutting Lot Line <br />N, S, E, W ft. <br />Approved By <br />Cfry Engineer <br />Issued <br />C7y�" <br />Inspection By ��—Geis✓ <br />DateInspected <br />No. 21574 <br />