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evereri <br />� <br />City of Everett <br />Engineering Department <br />Sewer Application and Permit <br />NO.�.-LOJO� <br />DATE <br />Service Address � Utility Account No. <br />Billing Address <br />j �1 � �=�''�j Connectian Permit I <br />City, State, Zip ` �` �� . ' Connection Fee_ <br />Owner (Mortgagor) _ _.- Total Fee <br />Billi�g Name - <br />Connection By <br />, -. <br />Phone <br />DESCRIPTION: <br />Lot <br />Block ' <br />Division or Add <br />Signed ' <br />c���om�� <br />Sewer District <br />Monthly Sewer Service <br />Monthly Sewer Constr <br />k�l <br />SEESKETCH ATTACHEO <br />_. _ �i���: <br />Auproved By — <br />C�ity Eneinecr <br />Issued <br />Connection By <br />Inspection By '�' ���""�"� <br />Date Inspected <br />�/ 3�1� � <br />