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,� <br /> - - . � � G ,�" - <br /> everett � ��� <br /> �e <br /> City of Everett <br /> Engineering Department <br /> Szwer Application and Permit � ��z 2 <br /> ,vo. �'0 2 2 3 / DATE ' - <br /> Service Address �- Utility Account No. <br /> Billing Address Connection Permit Fee <br /> City, State, Zip S - Connectiun Fee � <br /> Owner (Mortgagor)__ ' Total Fee -` _ <br /> Billing Name_ <br /> � <br /> Connection By <br /> Address � - _ -= Signed <br /> Cusromcr <br /> _. , -� ; <br /> Phone " <br /> DESCRI;TION: <br /> Lot <br /> Block �� <br /> Division or Audition ' �' ��� � --�' � <br /> Sewer District <br /> Monthly Se�ver: ervice �" <br /> Remarks: - ' '- _ <br /> .i. <br /> Monthly Sewer Constr. - <br /> ��f Ga-r� L`-o L•.. ��'^ • - . <br /> , Approved By � ' <br /> u � r7G �r S /, �� n � / City Enginccr <br /> 1-1� 0 � ALL�.�n.. <br /> Issued By <br /> -'� Connection By <br /> . / <br /> - - � G Inspection By A�,�� ' -•'��*---' <br /> ♦ Date I nspected_�_:[_� — <br /> �✓ i � <br /> � <br /> SEESKETCH ATTACHED <br /> I�;5PECTIUN <br /> —r_._. <br />