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----�--:� ; <br /> everett <br /> � <br /> City of Everett ���(lu� �������,f <br /> Eng;,�eering Department `, . �� ���`I <br /> Sewer Appiication and Permit <br /> � �_._�o <br /> N0. `,i iJ L �' t1 ✓ DATE —.��- ' �� � �— --- <br /> Sen�ic� Address ���`�'— ���R��� Utility Account No. <br /> P,illing Address Connection Permit Fee <br /> City, State, Zip _ Connection Fee <br /> Owner (Mortgagor) Total Fee <br /> Billing Name <br /> Connection By — <br /> Address Signed j�I/+P�i�"7' C/'/`�� >/ES <br /> Cusromer <br /> Phone --- <br /> DESCRIPTION: <br /> Lot _ <br /> Block <br /> Division or Addition <br /> Sewer District <br /> _ Monthly Sewer Service _ — <br /> Hemarks: ' !i.-..; - <br /> Monthly Sewer Constr. <br /> ,/L.+P�� �1 �� .a.vu9r.� J .��.v -- -�— <br /> `}��� — Approved By — <br /> /" City Engin�er <br /> Issued By -- — <br /> Connection By <br /> Inspection By�Gc���"Q� <br /> Date Inspected �•�� Y ' �� <br /> � <br /> SE[ SI(ETCH ATTACHEU <br />