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evrrett <br />City of Everett <br />Engineering Bepartment <br />Sewer Application and Permit <br />NO. DATE <br />Service Address <br />Billing Address__ <br />City, State, Zip__ <br />Owner (Mortgagor(_ <br />Billing Name <br />Connection By__ <br />Address— <br />Phone — <br />DESCRIPTION: <br />Lot <br />Block <br />Division.or Additinn <br />SEE SKETCH ATTACHED <br />Wj- <br />Utility Account No._ <br />Coruection Permit Fee <br />Connection Fee <br />Total Fee— <br />Signed - <br />Sewer District <br />Monthly Sewer Service__ <br />Monthly Sewer Constr. <br />Trunk <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />4pproved By <br />City Engine. <br />ssued <br />nspection By Q/ n�YJ CGv`� <br />ate I nspected�a'�/% G <br />NO. ?1449 <br />