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everett j % � L �1 " -iu� <br /> � I ` ( � � �� ^� / ; <br /> / ✓rl <br /> � <br /> ' ,l� / �}��. <br /> � . <br /> � <br /> City of Everett <br /> Engineering Oepartment <br /> Sewer Appiication and Permit ; � :, .�� <br /> N0. �� J1-� DATE ' <br /> Service Address Utility Account No. ` <br /> Connection Permit Fee � " <br /> Billing Address <br /> Connection Fee <br /> � City, State, Zip_.�---=�- ' " <br /> Total Fee — <br /> pwner (Mortgagor) ' <br /> Billing Name <br /> Connection By_-- <br /> � , ��� .� Signed c„:mm„� <br /> Address <br /> Phone <br /> DESCRIPTION: <br /> Lot�.= <br /> 81ock� <br /> Division or Addition Se�r,�er District <br /> Monthly Sewer Service_ -- <br /> Remarks: i - � - <br /> Monthly Sewer Constr. <br /> (7.�.,,,�� d':� -r�� ti;�� P L � <br /> �7 qpproved BY Cily Enginec� <br /> Issued By <br /> Connection By <br /> Inspection By K C a41G� a <br /> Date I nspected 3����`� <br /> .� <br /> SEE SKETCH ATTACHED It45PECTIOfV <br />