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evcretl <br />� <br />City of Everett <br />Engineering Department <br />Sewer Application and Permit <br />N0. DATE �— <br />Service Address_ �- Utility Accuunt No.. <br />Billing Address_ <br />- Connec[ion Permit F <br />City, State, Zip_ <br />� � �i ( i-- Connection Fee_ <br />Owner (Mortgagor) ! Total Fee <br />Billing Name_ <br />Cannection By_ <br />Phone <br />DESCRIPTION: <br />Lot — <br />Block — <br />Division or Addition <br />P � i <br />, <br />;„.j t� h <br />^�.; , Signed - <br />Cusmmer <br />Sewer Distnct <br />"Aonthly Sewer Service. <br />�ionthly Sewer Constr. <br />0 <br />SEE SICETCH ATTACHED <br />4pproved BY Ciry Engincer <br />Issued <br />Connection By <br />Inspection By—'� C` "����o� <br />Date Inspected�2 5 �-� y <br />� <br />;' <br />