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ever�tt <br />e <br />City of Everett <br />Engineering Department <br />�3-ZS1-5� ��'Si,�D l��o, <br />Sewer Application and Permit <br />�, <br />Np, .1, U L�.) J DATE <br />Service Address � `-� �E��"J <br />Billing Address <br />City, State, Zip � <br />Owner (Mortgagor�_ � <br />Billing Name <br />Connection By <br />Address <br />Phone — <br />DESCRIPTION: <br />Lot _ <br />Division or Addition � <br />Utility Account Nc <br />Connection Permit <br />Connection Fee_ <br />Total Fee <br />E <br />J <br />SEE SKETCH ATTACHED <br />t/ <br />��l <br />� <br />Sewer District __ — <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Approved By <br />City Enpineer <br />I SSU CCI <br />Connection By <br />Inspection By '`� ��"t'���`"""l <br />Date Inspected_?�� '��! 3 — <br />