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� , <br />evereR <br />e <br />City of Everett <br />Enpineerinp Dep�rtment <br />r <br />, <br />,,-j)_Z � <br />. , �., <br />Sewer Application <br />N0. _- DATE <br />? �� <br />, �J <br />' � � ;(; <br />,'' _ . <br />jx <br />and Permit <br />Service Address �- • ' ' - <br />Billing Address <br />Ci:y, State, Zip i <br />Owner (Mortgagor) <br />Billing Name " .'-/ '� <br />Connection By <br />Address <br />Phone <br />DESCRIPTION: <br />Lot - <br />Block_ - ' <br />Division or Addition <br />.-- <br />Utility Account No., <br />Connection Permit F <br />Connection Fee_ <br />Total Fee <br />Siyned <br />Cusromer <br />e <br />SEE SKETCH ATTACHED <br />Sewer District <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Approved By <br />City Engincer <br />Issued <br />Conner.tion 8 <br />Inspection By <br />�ate Insoectei <br />