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.�- <br />everett <br />e <br />City of Everett <br />Engineering Oepartment <br />Sewer Application and Permit <br />�; DATE <br />N0. _:_'_'.:. . �. <br />Service Address Utility Account No. <br />*, <br />:� � <br />Billing Address "=- — Connection Permit Fee <br />City, State, Zip �"'-r Connection Fee <br />Owner (Mortgagor) ' ' ' - Total Fee <br />Billiny Name <br />Connection By � — <br />Address - � � Signed <br />c�s�o�,�,,, <br />__ . <br />Phone ---- •--- <br />DESCRIPTION: <br />Lot ' <br />Block__` <br />Division or Addition ' <br />Sewer District__ <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />SEESKETCH ATTACHED <br />Approved Bti�_ <br />City Engmee' <br />�r.-- <br />ISSUCd BV � — <br />Cor�nection 8y— <br />Inspection By—_ <br />Dalclnspected_ <br />