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everett <br />� <br />City of Everett <br />Engineering Department <br />� .� � <br />� --?,r`�-,/� �e+,,C.:� /// �ji � � <br />Sewer Ap�plication and Perrnit <br />N0.64�Ov_l. / DATE <br />Service Address .5auti ,t7 _ Utility Account No. <br />Billing Address - Cannectio� Permit F <br />City, State, Zip - Connection Fee_ <br />Owner (Mortgagor) Total Fee <br />Billing Nam <br />Conner.tion <br />Address_ <br />Phone_ <br />���4I <br />Siyned <br />c�„�o,,,�� <br />DESCRIPTION: <br />Lot <br />Block � <br />Division or Addition <br />Sewer District /— . !. !�_ <br />.t�7 <br />SEESKETCH ATTACHED <br />Monthly Sewer <br />Monthly Se�n•cr Constr <br />Approved By_ _ <br />Clry Engincer <br />Issued <br />Connection By <br />� �1.,� <br />Insoection By��l <br />Date I nspected �� zi � z— <br />