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e�•erett ' �q / <br />.� I I L�r / <br />_ ,- �^ 'i` � <br />, j�. ('.. <br />City of Everett <br />Engineering Department <br />Sewer Ap�alication and Perrnit <br />N0. DATE <br />Service Address <br />Billing Address — <br />City, State, Zip ' ' <br />Ctwner !Mortgagor) '� <br />Rilling Name <br />Connection By __ _ __ <br />Address <br />Phone_ � <br />DESCRIPTION: <br />Lot <br />Block <br />Division or Addition <br />Utility Account No. <br />Connection Pe"mit f <br />Connection Fee_ <br />Total Fee <br />)' .' ` ; ii� <br />Signed . --_— — <br />Sewer Distrir,t <br />ily Sewer Serv�,�e <br />ily Sewer Constr <br />wed By <br />Ciry Enginccr <br />3 <br />SEF SKETCH ATTACHED <br />�ction By _ <br />i� , <br />tion'3y ��2��—��--�--�� <br />� <br />-�spected .3 ��� ? �� <br />� � <br />