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eyerett <br />� <br />City of Everett <br />Engineering Oepartment <br />Sewer Application and Permit <br />N0. .1, Cl �! 'J u " DATE � <br />� <br />=—____ .. ___.. <br />Service Address_ "' ' <br />Billing Address_ <br />City, S[ate, Zip_ <br />Owner (Mortgagor) <br />Billing Name_ <br />Connection By_ <br />Address <br />DESCRIPTION: <br />Lot <br />Block <br />Division or Addition <br />� <br />Utility account No. <br />Connection Permit I <br />Connection Fee_ <br />Tutal Fee <br />Signed <br />J <br />SEESKETCH ATTACHED <br />Sewer Dis[rict__ <br />Monthly Sewer Service <br />Monthly Sewer Constr <br />Approved B <br />� SSl! EC� <br />Enyinccr <br />Connection By — <br />Inspection By �-'!' ~ �'�++'-J <br />Datelnspected � � � -- <br />J <br />