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f <br /> I <br /> everPti I _ <br /> � <br /> City of Everett <br /> Engineering uepartment <br /> Sewer �,�apli .r.ation Qnc! Permit <br /> , �, <br /> N0. J_ i) � �j �� DATE � � .; .; • ,, <br /> Service Address ' Utility Account No._ <br /> Billing Address <br /> Connectinn Permit Fee <br /> City, SWte, Zip <br /> _ Connection Fee <br /> Owner (Mortgagor)__ _ Total Fee <br /> Billing Name <br /> Connection By " <br /> Address Siyned.__ <br /> c�n�over ----- <br /> Phone <br /> DESCRIPTION: <br /> Lot__ <br /> Block___ <br /> Division or Addition ' <br /> — _ Sewcr District <br /> Remarks: --, Monthly Sewer ServicP <br /> Menthly Sewer Constr.__ <br /> � / <br /> �e—�_���_e�_c��r4!O1Y 7 3 <br /> Approved By <br /> __ C�IV Enginccr — <br /> — -/��Ci-�c��.p--_A1s:�a�512-Ly <br /> � Issued By <br /> --- - - ----- <br /> -- i <br /> --- Connec[ion BY---____ _---- <br /> Inspection By_ <br /> Date Inspected____ <br /> ------- <br /> y/ - --- -�._----- -�— �------ <br /> SEESKETCH ATTACHED <br />