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everett � �� — � ` _ <br /> , � , , %� �'7��� <br /> � ," :.c ,�' <br /> � ,, �' /il:��' <br /> City of Everett <br /> Engineering Oepartment � <br /> Sewer Application and P�rmit <br /> rvo. 10397 � � U66 <br /> DATE <br /> Service Address Utility Account No. <br /> Billing Address ' <br /> Connection Permit Fee <br /> City, State, Zip . <br /> Connection Fee <br /> Owner (Mortgagor) Total Fee <br /> Billing Name <br /> i <br /> Connection By ' <br /> Address, • <br /> Signed <br /> PhOne � - ' Customer — <br /> DESCRIPTI <br /> Lot �� <br /> Block <br /> Division or Addition <br /> Sewer District <br /> Remarks: - Monthly Sewer Service ` <br /> Monthly Sewer Constr. <br /> y ., <br /> C�-'^--�-'-=�� �,..z .e.r _a <br /> al � � w dl .�.��1 r ,� � APProved By <br /> � — Gry Enginecr <br /> — — Issued By � �-- " <br /> ,�l ". �?C.c 16' ��£.� �,.-,�.�, � -naw ,t�-.*�,,�,n <br /> � <br /> o� ��� o� �Q� Connection By <br /> � Inspection By_ /,� � ��y,.;.�.�.� <br /> -- Date Inspec[ed � `� �y �3 <br /> .e — <br /> SEE SKETCH ATTACHED <br /> !i:SPECTP <br /> . <br /> � <br />