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,-- <br /> everett /,� _ � � ^, ��'.- � <br /> � � ' �_ D rr/Z -�/-� �� <br /> i�n- <br /> City of Everett <br /> Engineering Department <br /> Sewer Application and Permit <br /> ,i3119 <br /> NO.�Q `�2 r DATE ' . . <br /> Service Address -� ' � Utility Account No. <br /> Billing Address' 4 � ` Connection Permit Fee � _ <br /> Crty,State, Zip ` � Connection Fee <br /> Owner (Mortgagor) Total Fee " I <br /> Billing N2me <br /> Cannection By • <br /> Address - ,��� ' Signed_ � �. '-4:t��/ <br /> Cuctomer <br /> Phone <br /> DESCRIPTION: <br /> Lot <br /> Block <br /> Division or Addition <br /> I Sewer District <br /> i <br /> Monthly Sewer Service <br /> Remarks: <br /> Monthly Sewer Constr. <br /> M, �e�u � 5 so,.r N cc.JcL S ew �r L'Q ��� APProved By <br /> t'�—� �e�.�� _ 6�;, a `� Ciry Enginrer <br /> ��• �Jtc-� V� <br /> � <br /> �Y\J< w � <br /> Issued By _ <br /> Connection By _ <br /> Inspec[ion By <br /> Date InsF�cted <br /> i <br /> I <br /> :g/ <br />� SEE SKETCH ATTACHEp <br /> � INSP[CllOf:� <br />