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everett <br />� <br />City of Everett <br />Engineering Oepartment <br />Sewer a4pplication and Permit <br />NO. 1.(.� I,�-� L DATE --- - <br />Service Address � � ' � ' � Utility Account <br />Billing Address Connection Perr <br />City, State, Zip i.:- Connection Fee. <br />Owner (Mortgagor) Total Fee <br />Billing Name - <br />Connection By _ �-- <br />Address _>5 ' ' ' Signed 1`� <br />� . . .., <br />Cusiomer <br />Phone__ - :� i• , (' . <br />DESCRIPTION: <br />Lot _ <br />Block_ <br />- -, �,'�ri..� <br />Division or Addition — <br />SEESKETCH ATTACHED <br />INSPEC710�,! <br />� <br />Sewer District_ <br />Monthiy Sewer Service <br />Monthly Sewer Constr. "---- <br />Approved By - _.. . ; �" .� �.: G�; _� � <br />Gry Engmecr <br />Issued Bv ; -1 � <br />Connection By__ <br />Inspection By <br />)ate Inspected <br />