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� <br />evere:t <br />� <br />City of Everett <br />Engineering Department <br />�; � :� % r_ _ ,� <br />; �� :' � � - , - <br />`' ' ' ' <br />�S <br />C�, I�, <br />5ewer Applicat�on and Permit <br />n,a �-�315 � <br />Service Address <br />Billing Address _— <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Name _ <br />Connection By _ <br />Address - <br />DESCRIPTION: <br />Lot <br />Block <br />Division or Addit <br />DATE <br />Utility Account No. <br />Connection Permit I <br />Connection Fee_ <br />Total Fee <br />_ Signed <br />SEE SKETCH ATTACHED <br />If•15PGt1TlOi,l <br />Sewer District <br />Monthly Sewer Service_ _ <br />Monthly Sewer Constr. <br />Approved By <br />Ciry En�jinecr <br />Issued By <br />Connection By <br />Inspection By � ��C-C�--- - -- <br />_ L . , <br />Uate Inspected /.��1/7,3 <br />i <br />