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everett i:r . ") <`� � ' . � <br />,� ✓ <br />City of Everett <br />Engineering Oepartment <br />Sewer Qpplication ar�d Permit <br />N0. •-�- �� `� �> � DATE �� � <br />i: <br />Service Address Utility Account No. <br />Billing Address_ %� Connection Permit Fee_ <br />, <br />City, State, Zip %;,_T % Connection Fee <br />Owner (Mortgagor) �� -' ' Total Fee <br />Billing Name _ <br />Connection By " _ <br />Address �'�� �' �� r �� Sig�ied " � n • � _ <br />- , � , : Cusromer <br />Phone <br />DESCRIPTION: <br />Lot <br />Block _ <br />Division or Addition % % - `' � <br />, <br />Sewer District <br />�Qcnthly Sewer ServicE <br />Monthly Sewer Constr <br />J <br />SEESKETCH ATTACHED <br />ApproveJ [3y <br />City Enpinecr <br />Issued By ___ <br />Connection 6y <br />Inspection By � r-� «<<�� — <br />Date Inspected '''���� � _ <br />