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� everett � n_ � <br /> � ,��,� R4�i q�. � �,/. ,,_ <br /> _ e ; ;� � �-�� <br /> ,, <br /> City of Everett <br /> Engineering Department <br /> Sewer Application and Permit <br /> 3 �439 <br /> NO. ;� � Uvl� � DATE <br /> Service Address Utility Account No. <br /> ' , i <br /> Billing Address - � Connection Permit Fee <br /> - —_ _ __ _ __— <br /> Cit � % % � ' � Connection Fee <br /> y, State, Zip <br /> Owner (Mortgagor) � �-''� % � ',> ' Total Fee �' " <br /> Biiling Name � ' <br />' - <br /> Connection By : : _:' � ''� <br />', . � % ��- , ::� <br />� Address i- �� r ' - Signed "-f��—' <br />'' � .- �',�% . . , .� ' Customer <br /> � � <br /> PhOI1B <br /> i <br /> DESCRIPTION: _ <br /> � _ <br /> Lot - <br /> Block '� ' � <br />� ` -. l�r �> � .): i- <br /> Division or Addition ' f� ` � '�`� " � � ' ` ' <br /> Sewer District <br /> Remarks: � � ' ' -/ ; :,; . ". - ` , <br /> Monthly Sewer Service <br /> '1 !` � ' ' _. .. . . <br /> Monthly Sewer Constr. - ' <br /> —�D—l.vs� S - � <br /> — 'e.� ,,, <br /> � apn�ov�d ey , . . , <br /> f:iry Engincer . <br /> Issued By � <br /> Connec:ion By — — <br /> Inspection By <br /> Datelnspected <br /> � <br /> SEE SKETCH ATTACHED <br /> IIVSPE�TION <br />