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everen ' <br /> � �( _ 3 � - z � - S <br /> ,- �-�y > / %, <br /> City of Everett ' �� :. ��l <br /> Engineermn Uepartmant , • <br /> Sewer Application and Permit <br /> 3 �c,75 <br /> rvo. 1.0 15 � DATE _ <br /> Service Address - Q�e Utility Account No. <br /> Bitling Address - Connection Permit Fee <br /> City, State, Zip Connection Fee <br /> Owner (Mortgagor) Total Fee <br /> Billing Name <br /> Connection By - <br /> Address � " Signed �ti�- 1 ' o p�+ <br /> Customer <br /> Phone <br /> DESCRIPTION: <br /> Lot - <br /> Block � <br /> Division or Additio i ` �'� � •�"'�� • '� <br /> Sewer District <br /> Monthly Sewer Service <br /> Remarks: ? : J ,.i,.' / ';':'T � : <br /> Monthly Sewer Constr. <br /> �� � r, � !- 0� � r <br /> ,/ <br /> Approved By <br /> �� n� �` n � City Enginccr <br /> �� SO" <br /> Issued By <br /> Connection By <br /> Inspection By � � -/ ��t�"�/ <br /> Date Inspected����� — <br /> � <br /> SEE SKETCH ATTACHED <br /> INSPEC IIC,i <br />