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:,� <br /> � <br /> I <br /> � <br /> everett � <br /> e ��� -� , 2 � . � - _ <br /> ��� - � �, , . <br /> �� � � <br /> �� �, � ,, ,. :� <br /> City of Everett � <br /> , Engineering Department <br /> Sewer Applicat�ion and Permit <br /> 3 3:�5'7 <br /> i <br /> rvo.'�0499 DATE _ - <br /> Service Address_ � ��9 I�U• tjLE� Q 'J� Utility Account No. " <br /> Billing Address Connection Permit Fee " <br /> City, State, Zip Connection Fee ' ' <br /> Owner (Mortgagor) � . � ' -Total Fee � <br /> Billing Name <br /> Connection By - <br /> Address Signed <br /> Customer <br /> Phone _ � ` - <br /> DESCRIPTION: <br /> Lot � <br /> Block <br /> Division or Addition <br /> Sewer District .- ` � •� <br /> Remarks: Monthly Sewer Service ' � ' ' <br /> s .. <br /> Monthly Sewer Constr:_ '' <br /> � / ir �� � / JC �/ . <br /> V �.tivt . <br /> Approved By <br /> City Engmccr <br /> .,���,� ` <br /> Issued By <br /> Connection By <br /> Inspection By�.��t�'-fiy,-uh.-� <br /> Date Inspected ��-Z 'r�� Y <br /> � <br /> � � <br /> SEESKETCH ATTACHED <br /> INSPECTIOfV <br /> —c�: <br />