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evereri <br />� � .� g <br />/ `�.Z <br />City of Everett <br />Engineering Department <br />._� -��� ���'� <br />Sewer Application and Permit <br />NO.'�U�`I6 DATE <br />. .. <br />Service Address Utility Account No.. <br />Billing Address Connection Perrnit F <br />City, State, Zip f' �� Connection Fee_ <br />Owner (Mortgagor) /- Total Fee <br />Billing iJame <br />Connection By_ <br />DESCRIPTION: <br />Lot _ <br />Ci�oc� ___ ' <br />Divisi�n or Addition <br />_ , � <br />Signed � <br />Cusmmcr <br />Sewer District <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />SEE SKETCH ATTACHED <br />Approved By <br />City Enginccr <br />Issued By ' " <br />Connection By - <br />Inspection By � (�� <br />Date Inspected `" j � 3 <br />