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, <br />everetl � 2 �_ 7<:" <br />� � �� 1��;, i� �(- <br />City or Everett <br />Engineering Department <br />Sewer Application and Permit <br />N0. -��.� Z'� �c�Q / � DATE <br />J U <br />Service Address_�---�" <br />Billing Address_ <br />City, State, Zip__ <br />Owner (Mortgaaor�_ <br />Billing Name <br />Connection By_ <br />Address <br />Phone <br />DESCRIPTION: <br />Lot _ <br />Block. <br />Division or Addition <br />_ Util�ty Account No. <br />_ Connection Permit. I <br />_ Connection Fee__ <br />Total Fee _ <br />�„ <br />SC[SKETCH ATTACHED <br />;PGCTI�, <br />c,�t��,�,,,, <br />Sewer Disvict <br />Monthly Sewer Service _ <br />Monthly Sewer Constr. <br />Approved By. ___ <br />Ci�y Enginccr <br />�SSUed By _ <br />Connectian By — <br />Inspection By — — <br />Datelnspected ___ <br />