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:-w , <br /> �verptt � - • . <br /> U� 7 - , � -- Ll <br /> e � <br /> City of Everett � � � <br /> Engineering Department <br /> Sewer Application and Permit !� <br /> 3J�� � J <br /> N0. �O 5 O O DATE - ' <br /> Service Address ` - � � %�' � Utility Account No. " -' � �' � ' <br /> Billing Address Connection Permit Fee � <br /> City, State, Zip " � ' Connection Fae <br /> i <br /> I Owner (Mortgagor) Total Fee <br /> I <br /> Billing Name � '' ' _ <br /> r <br /> Connection By_ - <br /> ; Address '• �' ' ' � � � ! � Signed <br /> ' Customer <br /> Phone '� <br /> DESCRIPTION: <br /> � . <br /> L�,t <br /> Block <br /> Division or Addition � � � �' <br /> Sewer District �' <br /> ,- , <br /> -- Monthly Sewer Service <br /> Remarks: , . � ,, ; > . ,.Zi <br /> - r,. , <br /> Monthly Sewer Constr. ' � --� � <br /> Approved By ' <br /> Ciry Enginccr <br /> Issued By <br /> Connec[ion By <br /> � Inspection By � �!' <br /> Date Inspected � 7 <br /> :Fi <br /> SEESKETCH ATTACHED <br /> INSPECTI��� <br /> _�, <br />