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everett � <br /> � �e � � � - ��� b ,<< <br /> City of Everett , �'�" l � r r i�:'��f� <br /> � - <br /> Engineering Oepartment � <br /> Sewer Application and Permit <br /> 331�2 <br /> rvo.�� 422 DATE -- . <br /> _ .. ,; _ .:_ � _ . : , <br /> ; <br /> Service Address -- � ` ' Utility Account No. Y �- <br /> � Bil�ing Address Connection Permit Fee <br /> � i <br /> � City, State, Zip • � -1 : ! 1 1 Connection Fee �":%"� <br /> Owner (Mortgagor) _ Total Fee <br /> Billing Name ' -- <br /> Connection By_ — <br /> Address Signed <br /> ._ Customer <br /> Phone � � <br /> DESCRIPTION: <br /> Lot <br /> Block <br /> Division or Addition - <br /> — ;• i <br /> Sewer District ' / % <br /> Monthly Sewer Service ' <br /> Remarks: . .;,- �-. ,� � <br /> . <br /> - ,� ; � , , � Monthly Sewer Constr. <br /> �„ Approved By � , , �.- <br /> •� � � � CiIV Engmccr <br /> '/ i�����CS � � � /_ Issued By . � �. <br /> .-d e l, C �.-�_ �2.X t�-c t.-!</% 1� � :�-u. • <br /> 13G�� � <br /> — Connection By <br /> Inspection By - ��-�-.�. __� <br /> Date Inspected—i� !>: ' �� <br /> , - <br /> .P� <br /> SEESKETCH ATTACHED <br /> li:>rl_i.Tl(`; � <br /> ' y. � <br /> • `�. ,��—� . .� <br />