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ev,t•fett <br />.� <br />City of Everett <br />Engincering Department <br />Sewer Application and Permit <br />vo. 2.0019 � DATE '- <br />Service Address � Utility Account No.. <br />Billing Address ' ' Connection Permit F <br />I City, State, Zip Connection Fee_ <br />IOwner (Mortgagor) ' ' _ � Total Fee <br />� Billing Name <br />� <br />ConncctionBy ' � � ` � ''r- <br />� <br />� Address „ ; - ._ • ' ' � Signed ` <br />Customer <br />I <br />I Phone <br />I DESCRIPTION: <br />Lot _ _ <br />Block_ ' <br />Division or Addition <br />Remarks: <br />. — r. - <br />'�� ;! C�. ? % �.� - <br />__ _ _;. <br />-- ---- -- -- ---- ----- - ---- <br />� <br />I SEE SKETCH ATTACHED <br />Sewer District <br />Monthly Sewer Service <br />Monthly Sewer Constr <br />Approved BY � • `- : ` `-, <br />City Eagineer <br />Issued 8y - <br />Connection By <br />Inspection By ' <br />Date Inspected � ' <br />