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,-�-- <br />everett �J' �-.,'- �_g �— � <br />� � �' � : �!' '' /�l � �`, <br />r� <br />. <br />, ��,:.< s <br />City of Everett <br />Enginecring Oepai:ment <br />Sewer Application and Permit <br />NO..-i � J�J 1. DATE - <br />Service Address • �� ` ` <br />Billing Address ''' - <br />City, State, Zip "r - <br />Owner (Mortgagor) � ' _ <br />Billing Name <br />Connection By <br />�: � , : <br />� ^ .r � i <br />__ , � . i <br />Phone <br />DESCRIPTION: <br />Lot _ <br />Block <br />Division or Addition - ' - <br />Utility Account No. <br />> <br />Connection Permit Fee "- <br />Connection Fee <br />Total Fee_ �-- - "- <br />` � ���Signed �`� <br />Customer <br />Sewer District �`- <br />Munthly Sewer Service <br />Monthly Sewer Constr <br />� <br />Approvr� By <br />' CiryEn�ineer - ' �� <br />Issued By ' <br />Connection By— <br />Inspection By_ <br />Date Inspected <br />� <br />SEE SKETCH ATTACHED �;� ; �':,'�_, <br />INSPECTION <br />� .'" r �, <br />c: <br />v^;;=; <br />