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everett / , <br />e� <br />City of Everett <br />Engineering Department <br />, � ,L I . ( <br />I , ,p I � � �';{/ <br />, <br />Sewer Application and Permit <br />NO.'L-' � �7 �'� DATE " <br />Service Address � <br />� <br />Billing Address <br />City, State, Zip —� <br />Owner (Mortgagor) <br />Billing Name <br />Connection Bv <br />P.ddress_� ,'._- ` � % • �' . <br />. _. "�7 //"P ) <br />Phone <br />DESCRIPTION: . <br />Lot , <br />Block — <br />Division or Addition � � -- — <br />Utility Account No.. <br />Connection Permit F <br />Connection Fee_ <br />Total Fee <br />� ; , :q / <br />,' , <br />, ., <br />Signetl i11 <. �-r� �%i.�.-,.,. �_�i <br />Custamer <br />SEE SKETCH ATTACHED INSPECTIC>i <br />Sewer D'stric. <br />Monthly Sewer Service <br />Monthly Sewer Constr <br />Approved By � <br />City Enginecr <br />ISSUCd <br />Connection By <br />Inspection By <br />Date Inspected <br />