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cvert�tt <br />L6 <br />City of Everett <br />Engineering Bepattment <br />Sewer Application and Permit <br />NO. �i- (-����� I)Ai <br />Service Address <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor) — <br />Billing Name <br />Connection By— <br />Phone — <br />DESCRIPTION: <br />Lot <br />Block <br />Division or Addition <br />Utility Account No._ <br />Connection Permit Fee <br />Connection Fee <br />Total Fee <br />Signed — <br />Customer <br />Mo <br />Sewer District_— <br />nthly Sewer Service <br />Monthly Sewer Constr <br />Remarks: <br />Ap <br />�Ael C 5 (P <br />Issi <br />Co <br />----- — —— Ins <br />---- --- — — -- Dal <br />SEE SKETCH ATTACHED <br />)roved By <br />City Engineor <br />ted <br />inection By � <br />pection By <br />eInspected 19 Z 3 r <br />7 <br />SEE SKETCH ATTACHED <br />)roved By <br />City Engineor <br />ted <br />inection By � <br />pection By <br />eInspected 19 Z 3 r <br />7 <br />