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erveretS <br />1 <br />City of Everett <br />Engip .Jrg Department <br />Sewer Application and Permit <br />NO, DATE <br />Service Address <br />Billing Addres. <br />City, State, Zip____ <br />Owner {Mortgagor) <br />Billing Name <br />Connection By __ _ <br />Address <br />Phone <br />DESCRIPTION: <br />Lot <br />Block___ <br />Division or Addition_______________ <br />Utility Account No. <br />Connection Permit f <br />_ Connection Fee__ <br />Total Fee <br />Signed <br />customer <br />Remarks: <br />I <br />SEE SKETCH ATTACHED <br />Sewer District <br />M-nthly Sewer Service__ <br />Monthly Sewer Constr. <br />Approved By <br />cnv E„a...ee, <br />Issued By _ <br />Connection By _ <br />Inspection By (-94':e%L+t4� <br />)ate Inspected IN 7 `/ <br />