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everett <br />� � �� '��, <br />City of Everett <br />Engineering Department <br />Sewer Application and Permit <br />�, ; <br />NO. �:1_ l i c_ ._� ��_ " DATE <br />Service Address �� Utility Account No. <br />Billing Address Connection Permit Fee <br />City, State; Zip Connection Fee <br />Owner (Mortgagor) Total Fee _ <br />Billing Name <br />Connection By <br />� <br />Address_ - Signed <br />Customer <br />. 1 <br />Phone - <br />DESCRIPTION: <br />Lot <br />Block <br />Division or Addition <br />SEE SKETCH ATTACHED <br />Sewer District_ <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Approved By <br />Ciry Enginecr <br />ISSUCd <br />Connection E3y - <br />Inspection By�S_p^� < <�� ahc�J <br />Date Inspected � � 73 <br />