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evereft <br />� , <br />City of Everett <br />Engineering Department <br />""- L <br />i <br />� <br />Sewer Applicatian and Permit <br />rv o. .3: 0 � �; :i %. <br />Service Address <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor�_ <br />Billing Name ' <br />Connection By <br />DESCRIPTION: <br />Lot •�— <br />Block_ <br />Division or Addition <br />DATE _ <br />_ Utility Account No._ <br />_ Connection Permit Fee <br />Connection Fee <br />Total Fee_ <br />Signed :'��` � ' <br />.. -c65con,�� � � - <br />� <br />SEESKETCH ATTACHED <br />Sewer Di,tric, <br />Monthly Sewer Service <br />Mc,ithly Sewer Constr <br />Approved By_ <br />Ciry En9inicr <br />Issued B <br />Connection By <br />Inspection By �� U,'%'='�� — <br />Date l nspected� � -'' � <br />