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evecett <br />e <br />City af Everett <br />Engineering Uepartr�ient <br />r �i. <br />1�.. � <br />_ ��5���' <br />U <br />Sewer Ap�licction and Permit <br />NO.�-U�7� DATE <br />Service Address <br />Billing Address. <br />City, State, Zip <br />Owner (Mortga <br />Billing Name_ <br />Connection Bv_ <br />� Utility Account No. <br />Connection Permit f <br />Connection Fee_ <br />Total Fee <br />Signed <br />Customcr <br />,�s�r.�Y <br />,I ' r.—.... . � . <br />Phone__� -� <br />DESCRIPTION: <br />Lot <br />Block <br />Division or Addition � '�,,: � <br />Sewer District <br />Monthly Sewer Service � � _ <br />Monthly Sewer Constr. <br />SEE SKETCH ATTACHED <br />INSPECTION <br />Approved By ' " <br />Ciry Engineer <br />I ssued <br />Connection By <br />� <br />Inspection By � � ✓'u`� — <br />Date I nspected �/'2 �/� 3 <br />