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• everett <br />� <br />City af Everett <br />Engineering Department <br />��� �/ � <br />� �_G/- 6.2��/ ^5 <br />.,-- � -�" � ` <br />Sewer Application and Permit , <br />rvo. :� 0 5 4 0 DATE .' _" r_ '.' I� <br />Service Address . i C' "': '�� �r ,';:� ;''(. `�' '�' Utility Account No._ <br />Billing Address ,� Connection Permit Fee_ <br />City, State, Zip•�� %'•�� , %!' � Conneciion Fee " <br />� <br />Owner (Mortgagor) ' _ _ " Tc�al Fee ' <br />Bil�ing Name ' � - <br />� -- <br />Connection By --1 � .r � ; <br />_ �.; . <br />__. . � , <br />DESCRIPTION: <br />Lot ' � <br />, . '; <br />Block <br />Division or Addition_ <br />r� <br />r ' <br />Signed ' � <br />SEE StiETCH ATTACHED <br />ir:sr>rc nor�,� <br />,r�s <br />J iJ ;J �� <br />9 <br />Sewer District <br />Monthly Sewer Service � '' " <br />�' <br />Monthly Sewer Constr. - <br />Approv?d By �' <br />Qry En9ineer <br />I SSU eCJ <br />Connection By _ <br />Inspection By KGli/�GI.,J <br />Date Inspected�7`% <br />/ / <br />