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. i <br /> everetl � <br /> � � � <br /> �piU <br /> ����� ���� �� �� � <br /> i <br /> � I <br /> � ��f/��S � � , ', j�,� j .l � 1 � <br /> City of Everett <br /> Engineerir.g Uepartment ', ' <br /> Sewer Application and Permit <br /> �. <br /> � �:, :>.�.� r <br /> NO. .� '' ; DATE . <br /> Snrvice Address___ ___ _ i' !:;_ Utility Accawrt No. _ <br /> Billing Address ! Connectio,� Permit Fee - '— <br /> City, State, Zip � % .'. . - Connection Fee. _ <br /> Owner (Monyagor�_ , ; ! � ,, , ,...<-: ---- Tot�t Fee--- - -- <br /> Bi�ling Name � _ <br /> Connection BV- - ---------_ <br /> Address--- '� Siyned---.----- . ---. <br /> i:���.-v,���,., <br /> Phone -�--- ... •� -�• -,'. _ <br /> DESCRIPTION: <br /> Lot._��_.—. _ <br /> Block__�—_— — <br /> Division or Addition <br /> ------- -- Sewer District------------------ <br /> --- �, ,v, . � ,—;--� Monthly Sewer Service__- .___ <br /> Remarks: "' � ' � [ � � � — <br /> -- _ <br /> �-'� �-. , r'l_- [_�./ ..-! /, .� . ___� Mon�hly ,`ir��v�rt l:��ntit;._ . _ _ . <br /> -----� _ . _ . . _- — <br /> - — — - { Ap�n wed f1V— <br /> � - �-.1 ,2p I z 3 �,��E,,,�. ,, _-- <br /> --- __- - Issued Bv <br /> - Connection By <br /> Inspection By� �_—__ _ _ <br /> __ Datelnspected_��_ s� �.' � _ <br /> 1 <br /> v: <br /> _ _ -- _ ; <br /> SEESKFTCH ATTACHED <br />