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L <br />J <br />i <br />� I <br />City of Everett <br />Engineering Department <br />Sewer Application and Permit <br />NO. ,LO J —16 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 />Address Signed' <br />DESCRIPTION. <br />Lot <br />Block <br />Division or Addition <br />Sewer District <br />Monthly Sewer Service <br />Monthly Sewer Constr. r <br />Approved By <br />City Eng uvwr <br />Issued By <br />Connection By _ <br />Inspection By <br />Date Inspected_�r <br />JU <br />SEE SKETCH AT', ACHED <br />