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ever•ett <br />�� � <br />City of Everett <br />Engineering Department � <br />Sewer Application and Pero�it <br />. „ �. �.� � <br />NO. '+.��=!LJ DATE — <br />Service Address� <br />Billing Address <br />City, State, Zip <br />Owner (Mortyagor) <br />Billiny Name <br />Connection By _ <br />Address <br />Phone _ <br />DESCRIPTION: <br />Lot _ <br />Block _ <br />Division or Addi:ion_ <br />32�?_0 <br />� `!'-' Utility Account No. <br />' '- r `- � Connection Permit Fee <br />-_,ri <br />Connection Fee <br />' Total Fee <br />S <br />J <br />SEESKETCH ATTACHED <br />Sewer Distric[ <br />Monthly Sewer Service _ <br />Monthly Sewer Constr. <br />Approved By " `' < = - <br />Ciry En9inecr <br />Issued <br />Connection By <br />Inspection By <br />,",% .. � , � <br />Date Insnected_ - __ <br />