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everetl � <br /> '� I ' l l, f , <br /> �, <br /> � <br /> City of Everett <br /> Engineenng Department <br /> Sewer Application and Permit <br /> , � <br /> .> ,; ;34f <br /> NO. i `� � '{ " DATE <br /> Service Address __ Utiliry Account No. <br /> Billing Address Connection Permit Fee � <br /> City, State, Zip_ � ' '. _ Connection Fee_ <br /> Owner (Mortgagor) � �'+ - ' __ Total Fee__ __ _ <br /> Billing Name <br /> Connection By__ � <br /> Address__� '����, �., ,�. � �� ��� ; Siyned <br /> Phone <br /> DESCRIPTION: <br /> Lot _ _ <br /> Block---,----- <br /> Division or Addition_, <br /> _ Sewer Disirict <br /> — Monthly Sewer Service <br /> Femarks: -- — <br /> Monthly Sewer Constr. `—' __ <br /> � 5Y ����—lJ �s, •/-� ' �`' <br /> ��----- J — °`�� ApProved By — — <br /> / Cny Engm¢or <br /> i <br /> a'�� � Issued BY _. <br /> — Connectiun By___ <br /> Inspectian ByJZ c u �. /�,.,1 ---- <br /> Date Inspected___=���' 1 _ <br /> � ��-- <br /> —-------_ -- <br /> .Yi ._--------- ----- �----- <br /> SEESKETCH ATTACHED <br /> i �� <br />