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everett ' � <br /> e - - � � - �_ �, __ �� <br /> City of Everett j� �� � �,,2� <br /> Engineering Department � � � • � <br /> Sewer Applicotion and Permit <br /> ���l2S <br /> rvo. �.0226 DATE ' ' <br /> Service Address - ' ' _ Utility Account No. - - <br /> �, <br /> Biiling Address - , . <br /> Connection Permit Fee �" <br /> City, State, Zip - - �- �- <br /> Connection Fee <br /> Owner (Mortgagor) .' _ -:-:�: � _ �, ; ._ <br /> - = � Total Fee <br /> ;-i, . . y . - - . . _ <br /> Billing Name ' �. _ -, y< r' --� <br /> ; <br /> Connection By - - -: , , , � �. <br /> Address ' � "' � , � <br /> Signed <br /> PhO11B - � ' — � r" Customer <br /> DESCRIPTION: <br /> Lot <br /> —� <br /> Biock i <br /> Division or Addition - � � � : � - <br /> �_ <br /> Sewer District <br /> Remarks: -- - � � . 4, Monthly Sewer Service <br /> '- - - ' ��� � 4-' <br /> Monthly Sewer Constr. <br /> � Zc��F� <br /> � � ' w..�17 02/ � 5S APProved By ,r -.- - , <br /> "City Engineer <br /> J�S/.� � r / Issued By <br /> � »��F 5 .( .� . <br /> Connection By <br /> Inspection By ���i <br /> Date Inspected_.5 ,��73 <br /> / / <br /> _YI <br /> SEESKETCH ATTACHED <br /> !b!'_PECII�)f,� <br /> _S_. <br />