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everett <br /> �. L � <br /> � 1,:� 9-�C� 7� i � <br /> City of Everett � "� �"� <br /> Engineering Department J�� �Q <br /> Sev�er Application and Permit <br /> � <br /> NO. .:! •�J C11 iJ `� DATE _ <br /> ServiceAddress a7�� � OM�A/c?!� UtilityAccountNo. <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 _ Siyned - <br /> Customcr <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 /> i <br /> 3 o�:.P <br /> � Approved By <br /> City Eng�nr.er <br /> ' � _ _ <br /> �� <br /> — Issued By <br /> "` `—`� Connection By <br /> '� r! <br /> Inspection By � ��4 � (4 �° ^� <br /> 't' Date Inspected ��73 <br /> � <br /> ,�'iEE SItcTCN ATTACHED <br /> I\SPECTI:)I��! <br />