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, <br /> evere't - <br /> ( ' �� _ �`� ' M1 <br /> � r <br /> �� � �- ' �� <br /> City of Everett . <br /> Engineering Oepartment <br /> Sewer Application and Perrrrit <br /> � , . � <br /> NO. .�.I� iiU (} i DATE '�:. . :- _ - �� �.� �� J <br /> Service Address <br /> Utility Account No. - <br /> Billing Address � • <br /> Connection Permit Fee " <br /> City, State, Zip " , <br /> , �:, ' , Connection Fee _ __ <br /> Owner (Mortgagor) - ` ..--. <br /> Total Fee <br /> Billing Name <br /> Connection By � � <br /> Address �� Signed <br /> Phone � c�siomcr <br /> DESCRIPTION: <br /> Lot <br /> Block .- -' <br /> Division or Addition <br /> Sewer District <br /> Remarks: , ' �� Monthly Sewer Service <br /> Monthly Sewer Constr. <br /> � wPD� iL� �7 E �. <br /> Approved By <br /> Cfty En9inncr <br /> �� <br /> Issued By <br /> Connection By <br /> — Inspection gy � 0-tiv�,��.., <br /> Date Inspected ��j� �� <br /> t � — <br /> :� <br /> SEE SI<6TCH ATTACHED <br />