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everetl <br />�t <br />City of Everett <br />Engineerinp Department <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 />DESCRIPTION: <br />Lot <br />Block <br />Division or Addition <br />Type Permit: <br />■ SEE SKETCH ATTACHED <br />Utility Account No. <br />Connection Permit I <br />Connection Fee_, <br />Total Fee <br />Signed _ <br />wtam , <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 />Ir-iection By <br />Date Inspected <br />No. 21370 <br />