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everett <br />� <br />City of Everett <br />Engineering Department <br />✓' <br />► <br />- , _ �,; ' � <br />/� ,{ �, . , <br />. r�,��, <br />;� <br />Sewer Application and Permit <br />,- , <br />N0. -'�'_�.�; b D TE <br />/, ,�'w p y q �/ .�„� <br />Service Address.�/7 Utility Account No. <br />Biliing Address Connection Permit I <br />City, State, Zip ' Connection Fee_ <br />Owner (Mortgagor) ' � ' `�-- Total Fee <br />Billing Name �' <br />r . . P';'� � � . ' - <br />Connection By <br />Address Signed c�:�ome� —" <br />Phone • '-''�( <br />DESCRIPTION: <br />�ot � <br />Block <br />Division or Addition � <br />Sewer District <br />Monthly Sewer Service <br />Monthly Sewer Constr <br />0 <br />SEE SKETCH ATTACHED <br />_� <br />Approved By � - --. n /. � <br />Ciry Engineer <br />Issued Bv <br />Connection By <br />Inspecti�.� By %� ' �.<'C�,C-v�`'`.".—� <br />Date Inspected 9 y 73 <br />:�, ' <br />� <br />1- � <br />