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everett <br />e <br />City of Everett <br />Engineering Department <br />VIr <br />3 �' _•�y S <br />-7/YI/-7 if <br />Sewer Application and Permit <br />NO..10259-,-- DATE <br />Service Address <br />7 <br />Billing Address _ ✓yle <br />City, State, Zip <br />Owner (Mortgagor) `' el % <br />Billing Name <br />Connection By (T%t/,' <br />Address <br />Phone i d" <br />DESCRIPTION: <br />Lot <br />Block <br />Division or Addition <br />e„ <br />Utility Account No, <br />Connection Permit I <br />Connection Fee_ <br />Tot. Fee <br />Signed <br />Customer <br />SEE SKETCH ATTACHED <br />INSPECTION <br />Sewer <br />Monthly Sewer <br />Monthly Sewer Constr <br />Approved By <br />City Engineer <br />Issued By <br />Connection <br />Inspection By tO <br />Date Inspected �7j <br />