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everin <br />i � � '�. <br />' � <br />Fi -� ��, _.�� �%;� �. - <br />�� , ; <br />City of Everett �� �� <br />Eng�neering Oepartment <br />Sewer Application and Permit <br />N0. _ DATE _ <br />Service Address ' � � <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Name <br />Connection By ' <br />Address <br />Phone <br />DESCRIPTION: <br />Lot '' <br />Block <br />Division or Addition <br />Utility Account No. <br />Connection Permit I <br />Connection Fee_ <br />Total Fee <br />� <br />Signed � <br />Custamer <br />Sewer District <br />Monthly Sewer Service <br />Monthly Sewer Constr <br />e <br />SEE SKETCH ATTACHED <br />Approved By <br />Ciry Engmeer <br />Issued <br />Connection By. <br />Inspection By �� � �� t � <br />Date Inspected �y�� `� <br />