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. <br />eVere,h <br />� �� <br />� <br />City of Everett <br />Engineering Department <br />Sewer Application and Permit <br />NO. ��02 �✓ DATE � <br />Service Address�n� —�/O �j,{��_ Utility Account No. <br />Billing Address _ � <br />Connection Permit Fee <br />City. State, Zip " �. Connecticn Fee <br />Owner (Mortgagorj _ •; .Total Fee — <br />Billing Name 'J �� <br />Connection By ; � • <br />Address '- : J Signed <br />Customr.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 />SEESKETCH ATTACHED <br />Approved By <br />Ciry Engmcer <br />i — <br />Issued Bv � - ... <br />Connection <br />Inspection By � - _ <br />�atelnspected � • <br />