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everett <br />� � <br />City of Everett <br />Engineering Department <br />, � , t. <br />�� .� 1 � <br />I ���� '" <br />,O �� <br />�. ��-� � <br />,. <br />C� - <br />Sewer Application and Permit <br />NO. �� 1 � �i � DATE <br />Service Address • " <br />Billing AddreSs . .° <br />City, State, Zip_y 'c" •� <br />� <br />Owner (Mortgagor) � <br />Billing Name_ ' i�:`-� <br />Connection By_ <br />Address � <br />Phnna � � . � � . • , / <br />Uti�ity Account Nc <br />Connection Permit <br />Connection Fee_ <br />Total Fee <br />E <br />DESCRIPTION: <br />Lot ' <br />Block__, <br />Division or Addition ' <br />/ <br />' _ Sewer District <br />Monthly Sewer Servicc <br />Monthly Se�ver Constr <br />SEESKETCH ATTACHED <br />P[CTION <br />Approved By � <br />Gly Engineer <br />Issued <br />Connection By <br />Inspection By � � � - <br />Date Inspected_ `�� � 3� �'j <br />i <br />