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-� <br />evereti <br />� r j � <br />� <br />City of Everett " <br />Engineering Department <br />Sewer A��plicati�n ar�d Permit <br />NO. ,-. '� l� : � �� DATE <br />Service Address , - ' <br />Billing Address =� f� ` / ' =- <br />City, State, Zip � r= I? i= 7 <br />Owner (Mort:,agor{ �.. ;=�.'•'� - <br />Billing Name - _ <br />�.<:�o� <br />Utility Account Nc <br />Connection Permit <br />Connection Fee_ <br />; � Total Fee <br />Connection By i_- ,'� ' / � , <br />Address " � % � •=fIO� <� � � ;� `L Siyned <br />�. <br />, <br />Phone_ _____�_ <br />DESCRIPTION: <br />Lot �' <br />Block <br />Division or Addition <br />J <br />SEESKETCH ATTACHED <br />� <br />Sewer Dis'trict <br />Monthly Sewer Service_ <br />Monthly Sewer Constr._ <br />ApprovedBy ;J;=.;';,'{�;.: <br />City Engineer <br />Issued By ______ _ <br />Connection By _—_—__— _ _ _ <br />� , . <br />Inspection By � ' �.« ���.-J <br />Datelnsper.ted �� �� � � <br />