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everett ,� — :� � — Z �1 - 5 _ . - . <br /> � � � . � ` <br /> I � ,,/ fL � `' ., <br /> ,-� -k j�Jl1.� <br /> City of Everett <br /> Engineering Uepartment <br /> Sewer Application and Permit <br /> 3�57i <br /> N0. �_� � 5 � DATE � <br /> Service Address '�'r 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 <br /> Address .� ,�� � `" _ Signed_ <br /> a�:�om�� <br /> Phone " " <br /> DESCRIPTION: <br /> Lot <br /> Block <br /> Division or Addition ' �... : <br /> i � <br /> Sewer District <br /> Remarks: �� .' �_,;,' , ,, <br /> Monthfy Sewer Service <br /> Monthly Sewer Constr. <br /> � ��c�.�,.,,, � � ���-�`u1 e i � <br /> �� � APProved By_ - ` - _ <br /> Ciry Engineer <br /> �Or� �� � P � ` Issued By • �._ <br /> — Connection By <br /> � <br /> Inspection By�t i 9����c...� <br /> Date Inspected�•?0��3 <br /> sl <br /> SEE SKETCH ATTACHED <br /> INSP[CTIOf�I <br /> ,. <br />