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-. �.111 � �/ i ' _l . � � <br /> / , t '" <br /> � � _ � , ll '��;�I <br /> %xi/' <br /> i <br /> City of Everett <br /> Engineering Department <br /> Sewer Application and Permit <br /> 33251 <br /> N0. � � 4 � b DATE <br /> Service Address - _ Utility Account No. <br /> Billing Address - Connection Permit Fee ��`J <br /> � <br /> City, State, Zip ' �/ � Comiection Fee ` <br /> Owner �Mortgagor) ' =� 'i Total Fee <br /> Billing Name - <br /> Connection By - — � f <br /> -• .:, � - _ <br /> Addf¢55 ' ` ' � Signed f�� �� � Cuvomer � <br /> Phone �� •rc_:r' <br /> . -- �r i . <br /> DESCRIPTION: <br /> Lot " � <br /> 81ock <br /> Division or Addition - '-' -- <br /> Sewer District <br /> Monthly Sewer Service � <br /> Remarks: �/ �?� . �".' <br /> ' � Monthly Sewer Constr._ " <br /> � _ pproved By — I <br /> i C�ty[ngmcer <br /> � �'L� ilE.i.X-0v�/ .�t—I�.ti✓/ Lt,_crJ�] `� "' <br /> � p Issued By <br /> ��'�� .��s6�fi ""`�"�5� Connection By - <br /> Inspection By � '�--?�� <br /> Date Inspecled_���� y <br /> .YI <br /> SEE SKETCH ATTACHED <br /> INSPECTI��; <br />( <br />� <br />