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evcrett <br />� � <br />City of Everett <br />Engineeriu3 Department <br />Sewer Application and Permit <br />N0. � � � � DATE <br />Service Address ' <br />Billing Address <br />City, State, Zip <br />Owner (P.tortgagor) <br />Dilling Name <br />Connectia� By ' <br />Address ' �% '� <br />Phone <br />DESCRIPTION: <br />Lot <br />Divisian or Addition � " <br />Utility Account Nc <br />Connection Permit <br />Connection Fee_ <br />Total Fee <br />Sign <br />�] <br />SEESKETCH ATTACHED <br />Y <br />Sewer District <br />Sa <br />Monthly Sewer Service — <br />Nonthly Sewer Constr. � � <br />Approved By ` <br />Ciry Engmecr <br />Issued <br />Connection By— ---- ------- <br />� . . _ <br />Inspection Qy � �/�-�/-�'u'^—� <br />/ <br />Cate Inspected � �1'� 7 3 — <br />