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ever�4t <br />4� ' :._' ..' ,�" � <br />F _ /. <br />� i' J <br />�6 5 �� ��y���,r <br />City of Everett �)'��'��/' <br />Engineering Department <br />Sewer App�ication and Permit <br />rvo. �.�546 <br />.. : <br />Service Address ' , Utility Account No. - <br />Billing Address Connection Permit Fee " <br />City, State, Zip � ' _ Connection Fee . �- = '� �<�' „� � � <br />Owner (Mortyagor)_ Total Fee - <br />Billing Name <br />Connection Bv. " <br />DESCRIPTION: <br />Lot ' ` <br />Block <br />Division or Addition �_ <br />Remarks: <br />� <br />, � �o�r�, -t. YI7r, <br />i',Oo_ � � <br />.� <br />r _� � ✓� <br />�'- - _ <br />SEESKETCH ATTACHED <br />�` <br />Sewer District � <br />Monthly Sewer Service ` - <br />_ _ � :'�'-'�w - 1 <br />Monthly Sewer Constr._ - <br />Approved By � � <br />, Ciry Engineer <br />I1ISPLCI'ION <br />Issued <br />Connection By <br />Inspection By �; ��-rr/•"'�-�� <br />Datelnspected '3��`�f%`� <br />� <br />