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. - , _ <br /> , - <br /> everett <br /> • ` � <br /> � '_ <br /> City of Everett <br /> Engineerinp Department <br /> Sewer Application and Permit ;�z417 <br /> NO.a� � 7 2 DATE __ ' I <br /> �� '�t'% •�' ' _ Utility Account No. <br /> Service Address ' - - , � <br /> , ; � ! � �i , u; �,� _ Connection Permit Fee - � <br /> Billing Address ____ _. ' <br /> City, State, 2ip ' ' ' i�� � � / Connection Fee <br /> � Total Fee �— <br /> Owner (Mortgagorl - I <br /> Billing Name ' � ��" i <br /> Connection By <br /> , � : i f ..,. �'�; ; <br /> : <br /> Address ' ' � ' � . Signed � �����, <br /> Phone "� — <br /> DESCRIPTION; , <br /> . - <br />, LOI�—=— <br /> Block_ � �, � <br /> ���;•�,�� •/ � , v.. , - - - <br /> Division or Addition Sewer District <br /> Monthly Sewer Service <br /> � i ?/ � -- - ------- --- <br /> Remarks: .i Monthly Sewer Constr. <br /> '��� � APProved By i/ � � J �,. '�i. , _ ��_ <br /> Gty Enqmeer <br /> � � �� �� ��i <br /> ��.���-�i�+ _d.� �u.t�yss;r.� Issued By , <br /> "-7 7 <br /> / — Connection 8y <br /> ___ Inspection 8y ��l'��/"�°� <br /> i � <br /> - Datelnspected �� � S �� <br /> --------------- <br /> :YI <br /> SEE SKETCH ATTACHED ��,,;, �>r�.� i„�� <br />� <br />