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everett d! _ �� " ZY ' `' <br /> .e ; � <br /> � �ST�� <br /> , <br /> , �- <br /> City of Everett ' ' , <br /> Engineering Department <br /> Sewer Application and Permit <br /> .1 �.; ,.j �7 � <br /> NO. _l. � J `+� � DATE � � <br /> -� � -%l , , <br /> L.'�,^ ,' �'�, <br /> Service Address � Utility Account No. <br /> Billing Address ` Connection Permit Fee <br /> City, State, Zip '� ' Connection Fee <br /> Owner (fJlortgagor) ' To[al Fee <br /> Billing Name " <br /> Connection By <br /> Address Signed <br /> Cusmmer <br /> Phone — <br /> DESCRIPTION: <br /> Lot �� a <br /> B�ock /U � d � ��'.��KJ. <br /> Division or Addition —QIfS <br /> Sewer District � <br /> Nlonthly Sewer Service " <br /> Remarks: � <br /> Monthly Sewer Constr. �' <br /> �-r��.� ��A�..�_�� P APProved By ' ` <br /> (� City Enpincer r <br /> r 'r <br /> �SSUCCI BY <br /> Connection By <br /> Inspection By � ����'^"� <br /> uate Inspected 3 /Z � �, <br /> .� <br /> SEE SKETCH ATTACHED <br /> I i 15PECTION <br />