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ever <br />e <br />City of Everett <br />Engineering Department <br />Sewer Application and Permit <br />N0. - DATE <br />Service Address <br />Billing Address <br />City, State, Zip__ <br />Owner iMortgagori. C <br />Billing Name F <br />Connection By <br />Address <br />DESCRIPTION <br />s2611 <br />Utility Account No. _ <br />Connection Permit Fee <br />// �'`, <br />Connection Fee wU� 1!� <br />ti^ <br />Total Fee <br />Signed_ {`�.Y<S��l�►1�f' . <br />Customer <br />Lot <br />Block <br />Division or Addition • "✓ `% l� ��// 9 <br />Sewer District <br />Monthly Sewer Service <br />Remarks: ) ,/� r, •� . <br />i Monthly Sewer Constr <br />ti3" 3Ll Sw <br />y r <br />SEE SKETCH ATTACHED <br />INSPECTION <br />Approved B <br />City Engineer <br />Issued <br />Connection <br />Inspection By <br />Date Inspected( <br />