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everett <br />� <br />City of Everett <br />Engineering Oepartment <br />����,` <br />.�- �p0 S`7 <br />Sewer Application and Permit <br />NO. l.�i l �> � <br />Service Address <br />Billing Address <br />Ciry, State, Zip <br />Owner (Mortgagor�_ <br />Billing Name <br />Connection By <br />Address <br />Phone <br />DESCRIPTION: <br />Lot _ <br />Block <br />Division or Addition <br />DATE <br />Utility Account No. <br />Connection Permit I <br />Connection Fee_ <br />Total Fee_— <br />Signed Customer <br />Sewer District <br />"✓lonthly Sewer ServicE <br />Jlonthly Sewer Cnnstr <br />3�7 <br />SEE SKETCH ATTACHED i, <br />Approved By_— <br />c�rv <br />Issued B <br />Connection By <br />Inspection By ' <br />Date Inspected <br />