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. _ i <br /> ° I <br /> everettr �� V�(. � ��- '� � . <br /> � . <br /> City of Everett <br /> Engineering Oepartment <br /> Sewer Application and Permit <br /> / ;� �,444 <br /> rvo. 4 �� Uc; �' <br /> DATE _. <br /> Service Address Utility Account No. <br /> Billiny P.ddress_ Connection Pcrmit Fee <br /> 1 i , <br /> City, State, Zip ' � � � Connection Fee ' �_ • <br /> Owner (Mortgac�or) � f .' / �-c"'�� � _ Total Fee � _ <br /> BillingName - ' '/'% �� <br /> � � <br /> Conr.ection By_ ' '� �'•'"� ` � - _ <br /> Address-: � ' '�J% � <br /> � �/j Signed <br /> c��,i�,,,�•, <br /> Ptione` �_,, ' ) <br /> DESCRIPTION: <br /> Lot _ <br /> Block _ � <br /> Division or Addition � � <br /> Sewer District <br /> — Monthly Sewer Service � _ <br /> Remark,: ` . <br /> ----�-`---- <br /> Monthly Sewer Constr. � <br /> ��„��1--r±--�`-..�°`�- S-�� <br /> � <br /> /� p q"�� � Approved By �� �- � <br /> y �� \\ C/ C S 0 � � 7"u.e�liG s[-Gf+-�^ CitY Eng�neer <br /> — �����-- �_� i <br /> Issued By ' _______ <br /> Connection By <br /> inspection By��ILt�ef—�-�' _ <br /> Date Inspected� l�7-?-�7 2- <br /> - -- _ _ - - - - _- - - --___.. _---- <br /> .� <br /> SEE SKETCH ATTACHED <br />