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� <br /> everett <br /> � � � � 7�� � 1� - 4� � r / <br /> � . f � <br /> � <br /> City of Everett ��,'7 ��� <br /> Enyineering Dep[^ment <br /> Sewer Application and Permit � � <br /> 3�63 `� <br /> rvo. �0177 � DATE , . _ -- _' - ' a <br /> Service Address �h __ Utility Account No. <br /> �..`, — � <br /> Billing Address _ _ Connection Permit Fee �= .�' �I <br /> City, State, Zip_ " Connection Fee ' , <br /> Owner (Mortgagor) - Total Fee <br /> � ~ i <br /> i <br /> Oilling Name <br /> Connection By '� _ -r_� _ <br /> 1 . <br /> Address � '> ,.: .'. :��, � � �,::�� Signed_1: � � ' : T'� <br /> ,�� ' � ' Customer � <br /> Phone_ >�7 — `�L•' <br /> DESCRIFTION: <br /> Lot_. - ->� <br /> Rlac'c_ <br /> Division or Addition �'r,[ia • �Ji� <br /> — Sewer District � <br /> Remarks: - Monthly Sewer Service �—' <br /> �'i �, .� 4.. �if.. <br /> Monthly Se�ver Constr. - ' " <br /> 1 � ` <br /> -� . A roved B � :�, � <br /> PP Y— ' �. �!l <br /> �� _��7�� _.,.,�e.. �� City Engineer <br /> ����« <br /> — Issued By (� _ <br /> Connection By <br /> Inspection By <br /> Datelnspected <br /> a� <br /> SEE SKETCH ATTACHED <br /> Ii�;�;PECTfON <br />! <br />