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everett <br />e <br />City of Everett <br />Engineering Department <br />� �- _/ <br />j ^� ��p� ���.,�� � / <br />v� <br />Sewer Applicatic,n and Permit <br />NO. �� n � � � DATE <br />Service Address � <br />Billing Address " � <br />City, State, Zip �� <br />Owner (Mortgagor) f ,� <br />Billing Name <br />Connection By ' '!' ' <br />Address " <br />� i �: , , � � . .- . �_, <br />Phone - <br />DESCRIPTION: <br />Lot <br />Block <br />Division or Addition <br />Utility Account No.. <br />Connectian Permit F <br />Connection Fee_ <br />Total Fee <br />Signed <br />Custamcr <br />� <br />SE�SKETCH ATTACHED <br />:1L <br />Sewer Disvict <br />Monthly Sewer Service_ <br />Monthly Sewer Constr.. <br />Approved By <br />City Enginecr <br />Issued <br />Connection By---- <br />InspectionBy ���"� ����li� 4� <br />Date I nspected � ��! �� Z�_ `� <br />