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everen <br /> � ;� � <br /> � �. � t ` <br /> i )., � L� �P �/; ; /•� : , <br /> City of Everett > / � <br /> �' . <br /> Engineering Oepartment <br /> Sewer Applicction and Permit <br /> � �; � � � <br /> N0. ��-� 5 3 � DATE • � ' <br /> Ty�"es/�—f�r /�c✓ !�/�_ <br /> Service Address ' Utility Account No. <br /> Billing Address Connection Permit Fee <br /> City, State, Zip Connection Fee �'�` `, ,- -- <br /> Owner (Mortgagor) Total Fee '" ' <br /> Billing Name ` � �� ' <br /> Connection By _ >/1 "_ � �'--;' <br /> Address ' �'� �:- ;' < � � =�' Signed <br /> Cus�omcr <br /> Phone ' � ` <br /> DESCRIPTION: <br /> Lot ` � <br /> Block <br /> Division or Addition % " <br /> Sewer District " ' <br /> Monthly Sewer Service -- <br /> Remarks: ;� :, ( �, r �� N�: C ' -- ,' <br /> � _ , i5 <br /> ,�Q r ��v,< , . � � <br /> Monthly Sewer Constr. . <br /> � � <br /> , �' �� S�X 7 � Approved By <br /> City EnAlnecr <br /> ISSUeCJ By - � <br /> Y' a c -a�.�-� '� 2„�.K <br /> Connection By <br /> Inspection By - C li- /�lG.✓ <br /> Date Inspected��i� ?�/ <br /> � <br /> SEESKETCH ATTACHED <br /> INSPECTIOf�; <br />