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evprett <br />City of Everett <br />Engineeri:ig Department <br />Sewer Application and Permit <br />N0.1029b DATE <br />I <br />Service Address Utility Account No. <br />Billing Address � � ' Connection Permit Fee <br />JC, <br />City, State, Zip Connection Fee <br />Owner (Mortgagor) Total Fee { <br />Billing Name <br />Connection By <br />Address Signed <br />Customer <br />Phone <br />DESCRIPTION: <br />Lot <br />Block <br />Division or Addition -- <br />Sewer District <br />Monthly Sewer Service <br />Monthly Sewer Constr. _ <br />Approved By <br />City Engineer <br />Issued By <br />Connection <br />Inspection I <br />Date Inspec <br />SEE SKETCH ATTACHED <br />INSPECTION <br />