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evereri <br />� �, i <br />City of Everett <br />Engineering Department <br />Sewer Appliccation and Permit <br />NO. ' i! U.L I`� DATE <br />Service Address_ <br />Billing Address_ <br />City, State, Zip_ <br />Owner (Mortgagor�_ <br />Billing Name <br />Connection By <br />Address_ <br />Phone <br />DESCRIPTION: <br />Lot <br />Block <br />Division er Addition <br />u <br />— -� _ <br />_, _ <br />Utility Account No. <br />Connectian Permit I <br />Connectian Fee_ <br />Total Fee <br />.JI <br />SEE SKETCH ATTACHED <br />Sewer District <br />Monthly Sewer Service <br />Monthly Sewer Constr <br />3�:;��3 <br />Approved By <br />Ciiy Englnear <br />Issued <br />Connection <br />Inspection I <br />Date Insoec <br />; .—: ✓" <br />