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everett . ''' <br />� :� r , { <br />/ .. <br />City of Everett <br />Engineering Department <br />Sewer Ap�licetion and Permit <br />N0. r � �'; _L `�; � DATE <br />Service Address ` �''t`-' <br />Billing Address — <br />City, State, Zip <br />� . ;_ <br />Owner (Mortgagor) ' = <br />Billing Name <br />Connection By ' '" ' � � ` — <br />Phone_ __ _ ---_ - <br />DESCRIPTION: <br />Lot — _ <br />Block_-_ <br />Division or Addition__ _ _- <br />Utility Account No.. <br />Connection Permit F <br />Connection Fee_ <br />Total Fcc____ <br />Siqned---- -- <br />Cii.n�nrr <br />SEE SKETCH ATTACHED <br />Sewer District <br />Monthly Sewer Service_ <br />Monthly Sewer Constr._ <br />Approved By_ <br />Issued <br />Enginecr <br />, <br />Connec[ion By — <br />Impec:tion By l� � �-��" - <br />Date Inspccted_��� 3 <br />