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everett <br />e <br />City of Everett <br />Engineering Department <br />Sewer Application and Permit <br />NO. DATE <br />Service Adc <br />Billing Add <br />City, State, <br />Owner (Moi <br />Billing Nam <br />Connection <br />Phone <br />DESCRIPTION: <br />Lot <br />Block -- <br />Division or Addition_ <br />Type Permit: <br />SEE SKETCH ATTACHED <br />Utility Account No. <br />Connection Permit Fee <br />Connection Fee <br />Total Fee <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 Engineer <br />Issued <br />Inspection By — <br />Date Inspected_ <br />No. 2.1-575 <br />