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everep <br />L (� <br />City of Everett <br />Engineering Department <br />Sewer Application and Permit <br />NO. - DATE <br />Service Address <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor) — r <br />Billing N <br />i <br />Connection By - <br />Address -It <br />It Phone _ — <br />Utility Account No. <br />Connection Permit Fee <br />Connection Fee <br />Total Fee <br />Signed <br />Customer <br />DESCRIPTION: <br />Lot — — <br />Block — <br />Division C- 7 �` <br />_ - c <br />Division or Addition Y� <br />Sewer <br />M <br />onthly Sewer <br />Remarks: J''�. <br />MI <br />�.1 ,Cc�e m, o a �w`� J Al <br />�X2wh.t�w <br />/ „� n P/ Is <br />v <br />CI <br />Ir <br />Di <br />M <br />SEE SKETCH ATTACHED i;. WECf ON <br />mthly Sewer Constr <br />// <br />)proved By <br />City Engineer <br />i <br />f"1 <br />;ued By <br />mnection By <br />spection By-20"�" <br />ite Inspected_ ���S' 7 _ <br />t <br />M <br />SEE SKETCH ATTACHED i;. WECf ON <br />mthly Sewer Constr <br />// <br />)proved By <br />City Engineer <br />i <br />f"1 <br />;ued By <br />mnection By <br />spection By-20"�" <br />ite Inspected_ ���S' 7 _ <br />t <br />