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-�,- , <br /> everett ,, , ; Z�- � � <br /> ; ��,P ll- 2�'�° <br /> � ' � �✓�� <br /> City of Everett <br /> Engineering Oepariment <br /> Sewer Application and Perrnit y „�, s <br /> � 3249 _ .. <br /> ! N0. �� `� J 4 DATE - <br /> Service Address � Utility Account No. <br /> ' Biliing Address Connection Permit Fee = �' I <br /> �� <br /> City, State, Zip ' Connection Fee <br /> Owner (Mortgagor) Total Fee <br /> Billing Name <br /> Connection 8y " <br /> Address ! :. �-" ' � Signed <br /> , � �� � , cuztomer — <br /> Phone <br /> DESCRIPTION: <br /> Lot �r <br /> Block . ' ,� <br /> Division or Addition "" !c ' � <br /> Sewer District <br /> i <br /> Remarks: , , <br /> Monthly Sewer Service <br /> , � . <br /> Monthly Sewer Constr. <br /> �/NSlJ —�S �—/��' � <br /> � Approved By - � �� ' <br /> Ciry Engin¢er <br /> I <br /> ', ISSUed BY � - � <br /> Connection By <br /> Inspection By <br /> Date Ins�;ected <br /> �� ii <br /> . 4 ����I����i <br /> .� <br /> SEE SKETCH ATTACHED F ;� i'- <br /> INSPECTION a <br /> � <br /> J <br />