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everett <br /> e . _ <br /> � _. <br /> City of Everett <br /> � Engineering Ocpartmnnt <br /> Sewer Application and Permit <br /> rvo. ^�•� 495 33250 <br /> DATE _ <br /> Service Address ,� ' � Utility Account No. <br /> � <br /> Biiling Address Connection Permit Fee � <br /> City, State, Zip '�� Connection Fee <br /> Owner (Mortgagor�_ _ �� • Total Fee -- <br /> Billing Name <br /> Connection By <br /> j Address • 'J Signed ' � ._ <br /> � <br /> Customer ,� <br /> Phone - <br /> DESCRIPTION: <br /> Lot <br /> � 81ock— <br /> Division or Addition � <br /> � Sewer District <br /> �- Monthly Sewer Service '— <br /> Remarks: r � <br /> .. <br /> Monthiv Sewer Constr. <br /> i Ok�� �S c�o-.�.J � kNabl� �-v ���v � APProvedBy � <br /> I Ciry Engincer <br /> , S�V 4 ��� �PMo � Issued By - <br /> Connection By _ <br /> Inspection By <br /> � <br /> Datelnspected _ <br /> .�1 <br /> SEESKETCH ATTACHED <br /> I�:SPECTI(1PJ <br /> I� <br />