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- . . �_ . . _ <br /> everett j � � <br /> � . I ����, 7 '1 <br /> � � �1��Q � ;�� <br /> City of Everett � � �� <br /> l <br /> Engineering Oepartment <br /> Sewer Application and Permit <br /> rvo.;�032 � _ . > , �2928 <br /> DATE <br /> Service Address_- % _ Utility Account No. <br /> Billing Address Connection Permit Fee —'" <br /> City, State, Zip . : Connectio� Fee <br /> Owner (Mortgagor) � Total Fee --- <br /> Billing Name <br /> Connection By <br /> A.�dress ,'. � , . Signed <br /> Cusmmer <br /> Phone ' <br /> DESCRIPTION: <br /> Lot <br /> Block / <br /> Division or Addition � ; �/ <br /> Sewer District <br /> Remarks: ; � _ Monthly Sewer Service - <br /> T2U.V/f �,vty ` Monthly Sewer Const�� " o Z� <br /> — , <br /> � '� '^ L✓�7 �C 0 , <br /> /J p Approved By <br /> ��.C�a C S p �� ' City Engincer <br /> Issued By C� <br /> Connection By <br /> Inspection By �'��'-L�---�� <br /> Date I nspected g��S/7� <br /> .Y� <br /> SEESKETCH ATTACHED <br /> G•�`;u�.C71t�N <br />