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everett <br />� <br />City of Everett <br />Engincering Oepartment <br />� . : _:; .. - "- <br />0 <br />Sewer Application and Permit <br />N0. �- ��� 1�' :' DATE <br />. <br />Service Arldress ' <br />Billing Address � <br />CitY, State, Zip -i �- i <br />� • <br />Owner(Mortgagor��='�^�=�' --""^"^�r'.� <br />Billing Name . <br />Connection By � <br />; <br />Address i � � �� ����%a��;�:;- <br />� <br />Phone " � <br />DESCRIPTION: <br />Lot ' <br />Block <br />Division or Additinn <br />Utility Account No. <br />Connection Permit F <br />Connection Fee_ <br />Total Fee_ <br />� <br />SEESKETCH ATTACHED <br />Sewer District <br />Monthly Sewer Service <br />Mon[hly Sewer Constr. <br />� �. r'� <br />Approved By ; <br />c��v e�,e�����r <br />Issued Bv � � <br />Connection By <br />Inspection By—�� �.e�`�«<--- <br />, <br />Date Inspected l �"G 7� <br />