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everett <br /> � ' <br /> City of Evereit <br /> Engineering Department <br /> Se�v+✓er Application and'Permit � <br /> ��:�If� <br /> N0. ti�_.�.) _I_ J J �—�DATE - - <br /> �3c9� .Lc�,J✓//3 Kl 2 r� <br /> Service Address � � - Utility Account No. .__ <br /> __ _: <br /> Billing Address - - Connection Permit �ee <br /> City, State, Zip � Connection Fee <br /> Owner (Mortgagor) Total Fee <br /> Billinq fJame <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 /> w�.��., �r �'� 3iy ' 3 v'�s� <br /> , � <br /> L � Approved By <br /> Ciry 6igutcer <br /> Issued By <br /> Connection By— <br /> .� /�� <br /> Inspection By�'f�`""'' <br /> Date Inspected_�3 `� ' 3 _ <br /> J <br /> SEE SKETCH ATTACHED <br /> � �, i,�� <br /> � <br />