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everett � ? "'� -� <br /> �— � � — _ , <br /> � <br /> City of Everett <br /> Engineering Department <br /> Sewer Application and Permit <br /> 3�524 <br /> rvo. �012 1 DATE � • > <br /> Service Address '� � Utility Account No. � ' " � �" <br /> Billing Address - `""' Connection Permit Fee_ ' - �JO �—� <br /> City, State, Zip ' ' _ � Connection Fee �/�.•°� — <br /> Owner (Mortgagor) - Total Fee <br /> Billing Name -- <br /> Connection By_ - <br /> Address " `� Signed ' <br /> ' , , , , . Cusromer <br /> Phone =� -- ,';: � _ - - <br /> DESCRIPTIO��: <br /> Lot <br /> Block <br /> Division or Addition <br /> Sewer District <br /> Monthly Sewer Service <br /> Remarks: �, <br /> Monthly Ser �: i,onstr. <br /> .�� c� � � �� �- n�`� y�z. '�C� . �.,-�-,. <br /> Approved By ' <br /> /i 2 `1 S ��,� �� o Ciry Engincer <br /> Issued By <br /> Connection By <br /> Inspection By�/�S/ � 3 <br /> Datelnspected ��✓—l��>�-��-� <br /> .Y7 <br /> SEESKETCH ATTACHED <br /> G`!SPE('�l�lOi�l <br /> • : t �y <br /> � <br />