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everett <br />e <br />City of Everett <br />Engineering Department <br />�� � � � � <br />� � � <br />� - ,� , <br />, , � i� �� <br />Sewer Application and Permit <br />N0. DATE <br />, _ <br />Service Address <br />Billing Address <br />City, State, Zip . \ <br />Owner (Mortgagor) <br />Billing Name <br />�annection By <br />Address — <br />DESCRIPTION: <br />Lot <br />Block <br />Division or Addition ` <br />Utility Accou�t No. <br />Connection Permit f <br />Connection Fee_ <br />Total Fee <br />,_ <br />r _— <br />i <br />� •; ii � � -- <br />' _ . _ - <br />Signed <br />Cuemmer <br />0 <br />SEE SKETCH ATTACHED <br />Sewer District <br />Monthly Sewer Servicc <br />Monthly Sewer Constr <br />Approved By <br />City.Engineer <br />ISSIIEG� Ci <br />Connection By — <br />Inspection By�d� �'�-�-�''��� <br />Date Inspected `� s �`l <br />