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everett �— <br /> .e . �:� ,. _1 � _ � <br /> X - ,� _ 7� <br /> City of Everett `�� ' � ^ <br /> �a � /��-�� <br /> Engineering Department / <br /> Sewer Application and Permit <br /> 33391 <br /> NO. DATE '�� f � �� � ��'� <br /> ,,-- -- <br /> Service Address :`"l%" " ' � Utility Account No. -- <br /> Billing Address Connection Permit Fee -- <br /> City, State, Zip r : 'i . "-' : Connection Fee '-"- � <br /> Owner (Mortgagor) . '% � /��� � Total Fee - '---' <br /> i <br /> Billing Name � '� '�`-` <br /> Connection By � �- �/ :�"" -= i , v ?.'- •:� e r=- <br /> ; _ <br /> Address %/ ' � /�/. �'/i -? � Signed <br /> � Cusromer � ' <br /> � .. - � --� ! _ �.'7��.. <br /> Phone - `� `> • <br /> , : <br /> DESCRIPTION: ' <br /> Lot <br /> Block <br /> Division or Addition - <br /> Sewer District <br /> .-\ <_-, <br /> Monthly Sewer Service — — <br /> Remarks: - ; � ':� ,=�r- �i,�,- , <br /> _ Manthly Sewer Constr. � ` " " � � `� � <br /> , n •r, <br /> ! � <br /> !� ' ��'!�` �e � � ApProved By - <br /> City Engineer <br /> `� P CS � �' Issued Qy <br /> Connection By <br /> Inspection By � ���'''«'--^� <br /> __ Datelnspected �/�/�� <br /> u <br /> SEESKETCH ATTACHED <br />