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everett <br /> e � . .= -._ <br /> � : , - „ �,. <br /> , � , 2 _ ;�_ , <br /> -, ,:-. . .., q <br /> � �� �;,��t���. <br /> City of Everett ' - <br /> Engineering Department ' <br /> Sewer Application and Permit <br /> � 3 �08 <br /> rvo.'�.-0420 DATE - — ,' "; <br /> Service Address � � `-� - � ��'� Utility Account No. <br /> � x• <br /> Billing Address i " ' `' ^ � : Connection Permit Fee <br /> City State, Zip_ ' - � Connection Fee ' " �- " ' > <br /> - , . <br /> Owner (Mortgagor) � � �` r ��� __ Totai Fee <br /> Billing Name ' ` <br /> Connection By -�=�' S' <br /> Address �� � � '" Signed -- <br /> � <br /> . � � ,. ���, . ' Cus�omcr <br /> Phone <br /> DESCRIPTION: <br /> Lot <br /> Block <br /> Division or Addition ' -' ��: ! %- : ,-i -`• � � � - r � � <br /> Sewer District -" ' � <br /> Monthly Sewer Service <br /> Remarks: -.- , . ; , ,, � � .. <br /> _, ,f , Monthly Sewer Constr. r'�-`' <br /> Approved By ' - - � <br /> ;,;, . <br /> [� �� � � , �� Cily Engineer <br /> p Issued By <br /> � AG �SC� � � <br /> - Connection By_ <br /> Inspection B;��/��,,> <br /> Date Inspected /1/iA/73 <br /> � <br /> :9/ <br /> SEESKETCH ATTACHED <br /> ir;sr��cTin,� <br /> _-, <br />