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everctt <br />� <br />City of Everett <br />Engineering Department <br />J i <br />i �, ` <br />� (i• �� <br />, - ' <br />Sewer A�splication and F'ermit <br />NO. ��J � L �' �� DATE <br />Service Address � _- �� Utility Account ho. --- <br />�.. <br />- Connection Permit Fee ` � <br />Billing Address_ _ <br />. <br />City. State, Zip -' 7 • `-` Connection Fee <br />pwner (Mortgagor) ��;--_ '� �' Total Fee_ <br />Billing Name � � <br />Coimection By �' � ' <br />Address � ' .' =c': : ( :'/ - . i"_ . Siqned . � <br />Customrr <br />��lOf1C —___ . •—__-- <br />DESCRIPTION: <br />Lot <br />Block_.__— <br />Division or Addition . — <br />� Sewer District__ <br />P.lonthly Sewer Servic <br />Remarks• r .j. ; ...,,,,,. <br />— Monthly Sewer Consu <br />;Yl <br />SEESKETCH ATTACHED <br />Approved <br />Issued <br />e . — <br />Clty Enymcee <br />� ' <br />Connection By -- — <br />Inspection BY�-���T"'"� � <br />�� � <br />�ate �nspected_�r.- �_'�-- — <br />