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everett _� _ _ �_�7_ S = <br />� ,( <br />i' '�Z s�- � <br />_ �, ;. <br />City of Everett ` <br />Engineering Department <br />Sewer Application and Permit <br />No. ���� �i. <br />DATE <br />Service Address � <br />Billing Address <br />City, State, Zip <br />Cwner (Mortgagor) - - <br />Billing Name <br />Connection By ` <br />Address 7 � ' <br />Phone_ <br />DESCRIPTIOi�: <br />Lot _. _ <br />Block <br />Division or Addition_.__ _ <br />Utility Account Nc <br />Con�iection Permit <br />Connection Fee_ <br />Total Fee <br />Signed ' <br />Cunomer <br />J <br />SEESKETCH ATTACHED <br />��: sr�r� <br />� �-: � � „ <br />Sewcr District__ _ . , __ <br />Monthly Sewer Survice <br />Monthly Sewer Constr. <br />Approved By <br />Ciry Enpineet <br />Issued <br />Connection By — <br />'T <br />Inspection By ��'��%�''���'���—' � <br />Date Inspected "� � _ <br />1 <br />