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everett <br />� ��= .- , , _. : , <br />�- <br />City of Everett <br />Engineering Department i �• <br />i� <br />5ewer Application and Perrr�it <br />NO..�.U�i�i�'i <br />Service Address <br />Billing Address _ <br />City, State, Zip__ '' ! , � <br />Owner (Mort a o � � <br />DATE <br />:� <br />9 9 � -- <br />Billing Name ;i . <br />Connection By__ � : : <br />Address <br />Phone <br />DESCRIPTION: <br />Lot <br />Block <br />Division or Additinn . <br />_ Utility Account No. <br />_ Connection Permit F <br />�� Connection Fee <br />_ Tota! Fee <br />Signed` i <br />c�stomer <br />SEESKETCH ATTACHED <br />'�I"....� ., <br />Sewer District <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />; <br />; <br />Approved By ' ' - : j'� <br />Qry Enginecr �� <br />I SSU ECJ <br />Connection By_-��'�----- <br />Inspection By_,� `x.(_.�x� <br />��te lnspected_���-� 3 _ <br />