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evere� <br />e: .�, � << <br />City of Everett � � �� ��������� <br />Enginecring Department <br />Sewer Application and Permit <br />' � � � DATE <br />NO. �_LO c_ _� �_ <br />Service Address_ <br />Billing Address <br />City, State, Zip <br />Owner (Mor[gagor) <br />Billing Name <br />Connection By <br />Address '"� <br />� , <br />Phone <br />DESCRIPTION: <br />Lut <br />Block — <br />Division or Addition <br />�,. <br />Utility Account No. <br />Connaction Permit I <br />Connection Fee_ <br />Total Fee <br />Signed Cus�omr� <br />Sewer District_— <br />Monthly Sewer Service <br />Monthly Sewer Constr <br />SEESKETCH ATTACHED <br />Approved By <br />City Engmccr <br />Issued By <br />Connection By �7 <br />Inspection By �/ ''j���"'r�t�� _ <br />Date I nspected S/> //� 3 <br />� � <br />