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everett <br />� . <br />_ <br />City of Everett <br />Engineering Department <br />Sewer App�ieation and P'ermit <br />N0. L�.'�'-� i .- DATE `. = <br />Service Address 1,= • Utility Account No. <br />E3illing Address ` t� %� Connection Permit Fee ' <br />,,, - <br />City, State, Zip _/ Conneciian Fee "`� ' - <br />Owner (Mortgagor,___ - Total Fee __ <br />Billing Name_ _ <br />Connection By ' - ' ___. <br />Address ' � " _ Signed _ <br />. - - Cuvnmcr <br />Phone -- ____ <br />DESCRIPTION: <br />Lot <br />Block <br />Division or Addition ' — ___ . <br />J <br />SEE SKETCH ATTACHED <br />Sewer District <br />� , <br />Monthly Sewer Service f�'f'� _ <br />Monthly Sewer Constr. � ` <br />Ap�roved <br />Ciry Engincer <br />Issued <br />Connection By __— _ __- —_ <br />Inspection By �� �%!�L �-zr--� <br />Date Insoected ���' %�%� <br />