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everen I <br /> e , � � , ,.,� <br /> 1 � ,,n Sr /�� , <br /> ��, � �,,;-.f <br /> Ciry of Everett ;, �. � r- , <br /> Engineerinp Department � /�% <br /> Sewer Application and Permit <br /> J .. �� 4J <br /> NO. ..1 L) � l t'� � <br /> �°/�E�ATE`I�iNo ic'�) - <br /> Service Address Utility Account No. <br /> Billing Address - <br /> Connection Permit Fee -' <br /> City, State, 2ip � Connection Fee <br /> Owner (Mortgagor) Total Fee <br /> Billing Name <br /> Connection By <br /> Address <br /> Signed <br /> Phone ' c��s����„�., <br /> DESCRIPTION: <br /> Lot <br /> B lock______ <br /> Division or Addition <br /> - — Sewer District <br /> Remarks: Monthiy Sewer Service <br /> ____ _ _ _ Monthly Sewer Constr. <br /> �r1 /iYS�__��QtC/LZt-_?� <br /> ---- - <br /> _-- —._ <br /> _---- - - _ Approve� By � <br /> '___.__ QIY Enginexr <br /> Issued By <br /> - Connection By <br /> Inspection By_ <br /> Datelnspected <br /> � __--_— ----- <br /> SEESKETCH ATTACHED <br />