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everett <br />� <br />City of Everett <br />Engineering Department <br />-� �`� ,-_' �'- S <br />� ��_.-i. .r ; —5!�; <br />I �� � �, <br />Sewer Application and Permit <br />rvo. �.0234 <br />Service Address <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Name <br />Connection By _ <br />Phone <br />DESCRIPTION: <br />Lot <br />Rlock <br />Givision or Addition • � <br />DATE <br />Utility Account No. <br />Connection Permit F <br />Connection Fee_ <br />Total Fee <br />Signed <br />Customer <br />� <br />SEESKETCH ATTACHED <br />!�:': til'iCl' �Ir'.. <br />Sewer District <br />Monthly Sewer Service � <br />Monthly Sewer Constr. <br />Approved By � <br />Ciry Engineer <br />Issued By <br />Connection By <br />Inspection By �//-f�-�`--� <br />Date I nspected__ �� 6 �i3 <br />� � <br />