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everen <br />� <br />City of Everett <br />Engineering Department <br />,,�-� � l� <br />� � .. > <br />� � � � „ �; <br />; <br />�" � , ��, <br />Sewer Application and Perrr�it <br />No..lO�S(� <br />Service Address_ <br />Billing Address_ <br />City, State, Zip� <br />Owner (Mortgagor�_ <br />Billing Name <br />Connection By_ <br />Address <br />Phone <br />DESCRIPTION: <br />lot <br />Block <br />Division or Addition <br />DATE <br />� <br />_ Utility Account No. <br />_ Connection Permit I <br />_ Connection Fee_ <br />_ Total Fee <br />Siyned <br />�.11510111�'I <br />� <br />SEESKETCH ATTACHED <br />Sewer District <br />Monthly Sewer Service. <br />Monthly Sewer Constr. <br />Approvec <br />ty E��gmeri <br />Issued B <br />Connection By <br />InspectionBy—K<.J �-«��4�c.,; <br />Date Inspected i�' i c �'� <br />--�--- <br />