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ever.;�tt <br />� � <br />City of Everett I �. � � � � <br />Engineering Department 1 <br />S�wer Application and Perrr�it <br />NO. �) 'r, �. C C, DATE _ <br />� <br />3ervice Address ' — <br />Billing Address <br />City, State, Zip <br />Owner (Mort <br />Billing Name <br />Connection E <br />Phone <br />DESCRIPTION: <br />Lot _ <br />E!ock <br />Division or Addition <br />�Itili�y Account No.. <br />Connection Permit F <br />Connection Fee_ <br />Total Fee <br />Signed <br />;;ustomer <br />SEE SKETCH ATTACHED <br />Sewer District ' <br />Monthly Sewer Service <br />Monthily Sewer Cons[r. <br />Approved By_ <br />City Enginecr <br />Issued <br />Connection By <br />Inspection By �' �'� ���'�'t. —..�-.—� <br />Date Inspected '7 ���73 <br />