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everqn � <br />i. ?� - ;i � <br />e �- �����:,��. <br />, <br />City of Everett <br />Engineering Department <br />Sewer Application and Permit <br />No.�04C3 DATE <br />zc�o� �f,�� , , � - <br />Service Address "— --' <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Name <br />Connection By _ <br />Phone � <br />DESCRIPTION: <br />Lot • <br />Block <br />Division or Addition • <br />Utility Account No. <br />Connectioii Permit I <br />Connection Fee_ <br />Total Fee <br />Signed <br />c��t�o���� <br />.-7 <br />SEE SKETCH ATTACHED <br />Sewer District <br />Monthly Sewer Service_' <br />Monthly Sewer Constr. <br />Approved <br />c��v <br />Issued B <br />Connection By — <br />Inspection By a� �� ---' — <br />Date I nspected ����� � <br />