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everett <br />e <br />City of Everett <br />Engineering �epartment <br />� ,_� <br />J , �, �� <br />( .l - 7. / <br />1 <br />GJi'J f✓� <br />Sewer Application and Permit <br />rvo.:1 � 413 DATE <br />� <br />Service Address <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Name <br />Connection By <br />Address ` " <br />.,�--- - � ' <br />DESCRIPTION: <br />Lot <br />Block � ' <br />Division or Addition ; � � <br />Utility Account fVo. <br />Cannection Permit I <br />Connection Fee_ <br />Total Fee <br />Signed <br />Sewer Disvict _— <br />Monthly Sewer Service —'� <br />Monthly Sewer Constr. <br />SEESKETCH ATTACHED <br />Approved f3y <br />Ciry Engineer <br />I SSU Cd <br />Connection By --- <br />Inspection By <br />Date I nspected _ <br />