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evcrett % <br />,�� ��- ' � ��_z, <br />�� . L' � . �:! <br />� l ( � ,. <br />City of Everett <br />Engineering �epartment <br />Sewe►r Application and PerR�it <br />rvo. "1? i:) � :L �� ; <br />Service Address_— <br />Billing Address-- <br />City, State, Zip__ <br />Owner (Mortgagor�_ <br />Billing Name__ <br />Connection By_-- <br />Address <br />Phone , <br />DESCR�PTION: <br />Lot <br />Block <br />Division or Addition_ <br />DATE <br />Utility Account No.. <br />Connection Permit F <br />Connectinn Fee_ <br />Total Fee_ <br />Signed ' <br />Sewer District <br />Monthly Sewer Service_ <br />Nonthly Sewer Constr._ <br />6% <br />SEESKETCH ATTACHED �, <br />iJ <br />Approved By ^ <br />Ciry En9incer <br />Issued By _ <br />Connection By— <br />Inspection 8y <br />Date Inspe�:ted <br />