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Y <br />everett <br />City of Everett <br />Engineering Department <br />Sewer Application and Permit <br />NO.2.0529 <br />DATE <br />Service Address AIDD -3 <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Name <br />iConnection By <br />Address <br />i <br />Utility Account No. <br />Connection Permit Fee_ <br />Connection Fee <br />Total Fee -'— <br />Signed- <br />Customer <br />I <br />Phone <br />i DESCRIPTION: <br />Lot_ <br />Block <br />Division or Addition <br />Sewer District <br />Remarks: -2� <br />__ o <br />Monthly Sewer Service �• <br />ti 2•� ,(q T�,C,pc <br />Monthly Sewer Constr.-- <br />op <br />SEE SKETCH ATTACHED <br />Approved By <br />City Engineer <br />Issuer' By <br />Connection By <br />Inspection By <br />)ate InspectedJ'�� `� <br />