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everett _ � � — � �G2�.�1✓ <br />City of Everett <br />Engineering Department <br />Sewer Application and Permit <br />NO. 20781 DATE <br />Service Address <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Name_ <br />Connection By <br />Address C) . i <br />Phone <br />Utility Account No. — <br />Connection Permit Fee <br />Connection Fee__ <br />Total Fee— <br />Signed — <br />Customer <br />DESCRIPTION: Sewer District <br />Lot— <br />Block Monthly Sewer Service <br />Division or Addition ,.t , .;'. Monthly Sewer Constr <br />SEE SKETCH ATTACHED <br />Abutting Lot Line <br />N, S, E, W ft. <br />Approved By <br />City Engineer <br />Issued <br />Inspection By <br />Date Inspected /0 <br />NO. <br />