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everett <br />� <br />City of Everett <br />Engineering Oepartment <br />/ <br />(• ' <br />� <br />Sewer Application and Permit <br />NO. �- O J J � DAl"E _. <br />�_ Utility Account No.. <br />Service Address <br />Connection Permit F <br />Billing Address__—"--- <br />_ ,' Connection Fee_ <br />City, State, Zip <br />Tota� Fee <br />Owner (Mortgagor) — <br />Billing Name — <br />Connection By --�---- <br />Signed <br />� ' <br />Phone <br />DESCRIPTION: <br />�ot <br />Block_ — <br />Division or Add <br />� <br />Sewer District <br />"lonthly Sewcr Service — <br />llanthly Sewer Constr <br />SEE SKETCH ATTACHEU <br />� <br />�F)�]fOVO(� �Y_— Ci�v Englncor� <br />iS5U0d BY� — <br />COf1I18CllOf1 �Y --- � � <br />Inspection BY /� L� '"�-���� <br />Datelnspected �> > �� � 3 <br />