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evcr��tl <br /> � �� � ,_ r <br /> City of Everett <br /> Engineering Oepertment <br /> Sewer Application and Permit <br /> � �� ILJ <br /> NO. ".y� � ���� DATE ' <br /> Service Address � Utiliry Account No. <br /> , f , . � ,,.- ' --- <br /> Biiling Address "�"- Connection Permit Fee — <br /> �� ,.. . .: t -. ��-- <br /> City, State, Zip ' �'�'=� � ' �� ' " Connection Fee <br /> ,' � <br /> Owner (Mortgagor) ' T//` �-`-'t� ;''� '' Total Fee__ --_--- <br /> Bil�ing Name �' `� � � <br /> Conne,;tion By ' � � �° �' ' <br /> Address— . � � �' �., " ' '":' ' Siyned-- -- <br /> G�siu�n��� <br /> Phone '_- -- - _ - -- -- <br /> DESCRIPTION: <br /> Lot_____ <br /> Black _ <br /> Division or Addition • ' <br /> I Sewer District � __- <br /> Monthly Sewer Service — <br /> f� <br /> Remarks: ` � f i :�� '�� -�- <br /> -- Monthly Sewer Constr.__ _ <br /> —�— , w . ; � <br /> -- -- -- APProved By. _ <br /> cnv enginec, <br /> —� —__ — <br /> �- - Issued By <br /> _ _ ----- - _ <br /> - ---- <br /> ' U <br /> - ,�/ ---/�----_ __ .�� <br /> �✓0 /�.sr Af �� fl" ��-'/-- Connection BY— - _ <br /> �`M _ <br /> _ -- <br /> - .._. ... _. �I15DBCtlOf1 By.c � L�, <br /> _ . _ . ..__— ___"'_ . _ __ lr <br /> Date Inspected _-- -.. ___ <br /> - --1 - - -- -- -- <br /> -- -_._--- --i ' <br /> ---_ .._. ___ _ . .------._ . . . <br /> _. ... .. . ._ __ ----J <br /> � <br /> SEESKETCH ATTACHED <br />