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City of Everett <br />Engineering Department <br />Sewer Application and Permit <br />/7I1 S G1 NO. DATE <br />Service Address--.---- <br />— <br />Billing Address <br />'r ' <br />1 <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Name t <br />Connection By <br />o <br />Address_ <br />DESCRIPTION: <br />Lot /Block — <br />Division or Addition <br />Utility Account No. <br />Connection Permit Fee <br />Connection Fee <br />Total Fee f <br />Signed <br />Cuswmcr <br />Sewer <br />M <br />onthly Sewer <br />Remarks: (- <br />-- MI <br />rN �l Al <br />t1( rig Y1 t wsp 3,4 S7 . g t�� f IS! <br />C1 <br />It, <br />D; <br />SEE SKETCH ATTACHED <br />)nthly Sewer Constr <br />)proved By <br />Coy rna,ne�r <br />;ued <br />mnection B <br />spection By �Jt <br />ite I nspected 3�2- Z/7 <br />SEE SKETCH ATTACHED <br />)nthly Sewer Constr <br />)proved By <br />Coy rna,ne�r <br />;ued <br />mnection B <br />spection By �Jt <br />ite I nspected 3�2- Z/7 <br />