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City of Everett <br />Engineering Department <br />Sewer Application and Permit <br />NO. -10488 <br />DATE <br />Service Address <br />Billing Address ---- --- <br />City, State, Zip -- <br />Owner (Mortgagor) _— <br />Billing Name <br />Connection By _ <br />Utility Account No._ <br />Connection Permit F <br />Connection Fee_ <br />Total Fee_ <br />Signed <br />Phone -- <br />DESCRIPTION: <br />Lot <br />Block — <br />Division or Addition - l /i <br />Sewer District <br />Monthly Sewer Service <br />Remarks: ; <br />SEE SKETCH ATTACHED <br />Monthly Sewer Constr <br />,, 1 <br />Approved By_ <br />City E�19111er, <br />Issued <br />Connection By <br />Inspection By <br />Date Inspected 7 / 7 <br />INSPECTION j <br />9rr�►)aa>a�.....«a.o....._..,.�........... <br />