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evered <br />City of Everett <br />Engineering Department <br />Sewer Application and Permit <br />NO. "0 , OATS -- - -- --- — - - - <br />Service Address_ _ Utility Account No. <br />Billing Address__ Connection Permit Fee <br />City, State, Zip Connection Fee <br />Owner (Mortgagor) Total Fee <br />Billing Name <br />Connection By <br />Address <br />DESCRIPTION: <br />Lot <br />Block <br />Division or Addition <br />Remarks: <br />SEE SKETCH ATTACHED <br />Sewer District _ <br />Monthly Sewer Service_ <br />Monthly Sewer Constr. <br />Trunk <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. •, L <br />✓ /ii¢- <br />