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everett � � C�— �r <br /> �. <br /> e �� � � � <br /> , �, <br /> � ,� �- �� <br /> �; : <br /> City of Everett <br /> Engineering Oepartment <br /> Sewer Application and Permit <br /> , , 3334� <br /> N0. ��-`� 5 �� � DATE -- r <br /> Service Address ' ' - ' -•'— Utility Account No. <br /> Billing Address ` Connection Permit Fee '—"� <br /> City, State, Zip " " ' Connection Fee � <br /> � <br /> � i <br /> Owner 4Mc•*gagor) ' ' 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 /> Monthly Sewer Service — <br /> Remarks: <br /> ' Monthly Sewer Constr. <br /> �1/_�./�P����/�z - ' <br /> � Approved By - � � <br /> C�ry Engmeer <br /> Issued By <br /> Connection By <br /> Inspection By— <br /> Date Inspected_ <br /> .m � <br /> SEESKETCH ATTACHED <br /> I°:SPFCTION <br />