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- <br /> le <br /> 10 <br /> City of Everett <br /> Engineering Department <br /> Sewer Application and Permit <br /> 3553 <br /> No. 10140 /06 DATE �T <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 /> Address Signed cu:mmm <br /> i <br /> Phone <br /> DESCRIPTION! <br /> Lot — <br /> Block_ <br /> Division or Addition <br /> Sewer District <br /> Monthly Sewer Service <br /> Remarks: <br /> Monthly Sewer Constr. <br /> Approved By CIy i Enainerr <br /> Issued By <br /> Connection By <br /> Inspection By <br /> Date Inspected <br /> SEE SKETCH ATTACHED <br />