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evereft — <br /> C - �� 7� � / <br /> � � - , , � � � <br /> City of Everett -- <br /> Engineering Oepartment ,� Z�rj 8 <br /> Sewer A►�plication and Permit <br /> NO. �Y-O O � 3 •� DATE <br /> Service Address Utility Account No. <br /> Billing Address Connection Permit Fee <br /> City, State, Zip ` ' �'� Connection Fee ` " <br /> Owner �Murtgagar) Total Fee ' <br /> Billing Name <br /> Connection By <br /> Address Signed <br /> CustJ�+er <br /> '� Phone <br /> DESCRIPTION: <br /> Lot <br /> �_� � � <br /> Block ---- <br /> Division or Addition <br /> ,' - <br /> -• Sewer District <br /> ---� _ Monthly Sewer Service - <br /> Remarks: _ <br /> Monthly Sewer Constr. <br /> ,!� <br /> . APProved By <br /> . � <br /> _� . • , Ciry Engineer <br /> Issued By <br /> / `� (°�^^^2 `r "'L«i"� (� ��-��p-�-/ �,'^-'"-`'`' � Connec[ion By <br /> ' >W C.ti,. iv--C� � � �; �.->'�� <br /> � <br /> Inspection By Z �. r �'� �:`"'`�' <br /> [ -�,�`�i.iV -zz�.w�. � .�-�'-�(�'� i.�r - Oate I nspecte:'� ��"�`/7 li <br /> � <br /> SEESKETCH ATTACHED <br /> IidSPECTIOi`! <br /> .v� <br />