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everen <br />� / <br />City of Everett <br />Engineering Department <br />� c- <br />� ,� � �. <br />, <br />� <br />Sewer ARplication and Permit <br />No. �s�9 <br />DATE _ _ " <br />Service Address Utility Account No.. <br />Billing Address ' Connection Permit F <br />i <br />City, State, Zip ' � Connection Fee_ <br />Owner (Mortgagor) ' Totai Fee <br />- - �:: . <br />Billing �lame —� <br />Connection Bv_ <br />DESCRIPTION: <br />Lr: <br />Block <br />Division or Addition <br />Signed <br />Customer � <br />SEE SKETCH ATTACHED <br />Sewer District <br />Mo�;tlily Sewer Service_ <br />Monthly Sewer Constr._ <br />Approved By <br />Ciry Engmeer <br />I ssu ed <br />Connection <br />Inspection I <br />�ate Insoeci <br />