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evereA � <br /> e � � � �� � <br /> � <br /> City of Everett � <br /> Engineering Oepaitment � <br /> Sewer Application and Permit <br /> � .i ,�ti� <br /> NO. �- '�"� I� DATE <br /> Service Address � � Utility Account No.__ <br /> Billing Address Connection Permit Fee -- - <br /> City, SWte. Zip ' , Connection Fee_ <br /> Owner (Mortgagor) ' Total Fee ' ' "- <br /> Billing Name <br /> , <br /> Connection By _ � ' / <br /> Address ' ' Signed_ � < :/�— <br /> / cu:tamer <br /> Phone-- --- ---- _ _ .d . _ _ _ _---- <br /> DESCRIPTION: <br /> Lot _ <br /> Block=__.__,_ <br /> Division or Addition :': .� ' `. � <br /> ��, <br /> __ � Sewer District_ � <br /> Monthly Sewer Service `' <br /> Remarks %- J�, - � <br /> — � <br /> Mon[hly Sewer Constr. <br /> . <br /> �� .?y��—�����v�1]I-- APProved By � <br /> / Cny Enginrcr <br /> � - —_ <br /> . / �2 �SSUCO B�/ � <br /> -- — -- Conneclion By —__ <br /> inspectio � By��h����+-� - <br /> ��1�'Y <br /> Date Inspected. __ --- <br /> :� _ _ .. <br /> SEE SKETCH ATTACHED <br /> � i�, <br /> F <br />