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everett <br /> � � — ��w � , <br /> , >� <L�P ,,, <br /> , _ . � <br /> City of Everett / J � � � �� <br /> �S '� ,', � g <br /> Engineering Oepartment <br /> Sewer Application and Perrni# <br /> f� :� ;,i `' � DATE _ <br /> N0. __ . , " � <br /> Service Address a 7/-� � nJ��A�p Utility Account No. <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 Signed <br /> Cuslomer <br /> Phone <br /> DESCRIPTION: <br /> Lot_ <br /> Block <br /> � r <br /> Division or Addition /"��r� '� t- %1�r ,_,� _ <br /> Sewer District <br /> _ - Monthly Sewer Service <br /> Remarks: � /� <br /> Monthly Sewer Constr. <br /> Approved By <br /> City En9ineer <br /> _ i` e«P Issued By <br /> G�- ' <br /> Connection By — <br /> Inspection By ��- � ' �� <br /> Date I nspected��7 3 <br /> /iLl-� <br /> �- N <br /> J <br /> SEESKETCH ATTACHED <br />