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everztt / _ �_'1c�_ �— <br />�S <br />� _ <br />City of Everett <br />EnginePring Oepartment <br />5ewer �4pplicat�on and pe�i�rr�it <br />N0. ;�_.I' I�"% � DATE _ <br />,iervice F,ddress �� •- Utility Acccunt No._ <br />3iCiny Address Connectian Permit Fe <br />City, State, Zip ronnection Fee_ <br />Owner (Mortgagor) " � - " ' Total Fee <br />Billing Name <br />Connection By _ ' <br />Address � Siyned_ <br />Phone <br />DESCRIPTION: <br />Lot <br />Block <br />Divisicn or Addition <br />� <br />SEE SKETCH ATTACHED <br />Sewer Disirict___ <br />Monthly Sewer Service_ <br />iNonthly Sewer Constr._ <br />Approved By � � � ' � _ <br />City Enginecr <br />Issued [iy %' ` r _ <br />Connection By <br />Inspec[ion By _ <br />Date Inst�ected ___ <br />