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everett <br />e <br />City of Everett <br />Engineering Department <br />� <br />i; ;� � , <br />� 2>/r <br />t�J1/U ;� -�,;=i <br />i7 � , <br />/ <br />Sewer Application and Permit <br />N0. �O I_ �� �i � DATE � � " � <br />Service Address - Utility Account Nc <br />Billing Address Connection Permit <br />City, State, Zip Connection Fee_ <br />Owner (Mortgagor) Total Fec <br />8illing Name <br />Connection By <br />n.�,��o« i , _ � -;--- - <br />Siyned_ <br />Qistomer <br />DESCRIPTION: <br />Lot <br />Division or Addition <br />J <br />SEE SKETCH ATTACHED <br />Sewer District <br />Monthly Sewer Service <br />Monthly Sewer Constr <br />Appraved By _ <br />City Eng�m��rr <br />I SSU C(� <br />Connection By __—_ -_ <br />Inspection [3y <br />Datelnspected � �l 7 F' <br />