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everett <br />� <br />City of Everett <br />Engineering Department <br />� '� - ���`� - � ��, - c <br />J <br />Sewer ApWlication and G'ermit <br />No.�L�iL;:. <br />DATE <br />Service Address � "" ` �'`� y <br />Biifing Address <br />� <br />Utility Account Nu. " <br />Connection Permit Fee �� ~ <br />City, State, Zip ' --'�"�' Connection Fee <br />Owner (Mortgagor) - � � � r � 7 � • C � ��- j Total Fee �'� � , � <br />r � <br />Billing Name <br />Connection By " , � E �' �" ', � ��` ! �_ i --; f--= ' ,. <br />Address -�' ` F- F 7' "/ Signed % <br />Customer <br />Pho <br />DESCRIPTION: <br />Lot _ <br />Block ,' <br />Division or Addition, <br />� c r t " <br />Sewer <br />� <br />SEE SKETCH AITACHED ��VSPECTION <br />Monthly Sewer Service <br />Monthly Sewer Constr. -'� <br />l� - f f/,s�� ; "> <br />Approved By ' � � ' '' G <br />City Engineer <br />� <br />Issued By '` � ��� <br />Cannection <br />Inspection By �'/�-�"'""�"� <br />Date Inspected / ��'���7Y <br />� <br />J <br />