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evcr^tt <br />� <br />Cir• of Everett <br />Engineering Depanment <br />/ <br />,� ' �.;'l� : <br />� <br />Sewer Application and Permit <br />NO. ��_O =� (' � DATE <br />Service Addre:s <br />Billing Address � <br />CitY. State, Zip . . . . � ' . <br />Owner (Mortgagor) ;': - <br />Billing Name <br />Connection By <br />: <br />Address � '� �� �} % <br />Phone — --------- - <br />DESCRIPTION: <br />Lat <br />Block <br />Division or Addition __ <br />Utility Accaimt No. <br />Connection Permii f <br />Connection Fee_ <br />Total Fee <br />�.:�,�:�ti <br />Signed----_— <br />-- -c �.�,-;, �- --. _ .. _ _ . ---- <br />� <br />SEE SKETCH ATTACHED <br />>��c.� � 'u�„��.�.� <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Approved By + �• '� <br />Ciry Engineer <br />Issued <br />Connection By �- <br />Inspection By � O � �''`'ti"`� <br />Date Inspected 7�7� / <br />