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everen <br />e <br />City of Everett <br />Engineering Oepartment <br />Sewer Application and Permit <br />�,_. <br />NO. ,-'J ��::; 1 DATE <br />- , <br />Service Address �- � <br />Billing Address � `J <br />, t- - •, T �/�� <br />City, State, Zip <br />; _i <br />Owner IMortgagor) � °" '� — — <br />Billing Name %'��'-- <br />�. i <br />Connectian By r £ �= ' '�' ' _ <br />Address <br />Phone <br />DESCRIPTION: <br />Lot <br />Block '�� <br />, . - <br />Division or Addition - ' "" f — <br />Utility Account No. <br />Connection Permit i <br />Connection Fee_ <br />Total Fee <br />3 <br />a <br />SEESKETCH ATTACHED <br />�� � 3. <br />�:�(..�. � � r_�- <br />,f 7 <br />� <br />Sewer District_ <br />Monthly Sewer Service <br />Monthly Sewer Constr.____ <br />Approved E3y_ � _—_ <br />Gry Engincer <br />Issued <br />Connection By—�_V�-��"`��{=Y <br />InspEction By �� �'�� �%Y'� — <br />Date !nspected��� _ <br />