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� <br /> everett <br /> � \. <br /> -� <br /> City of Everett <br /> E^nineering Uepartment <br /> Sew�r Application and Permit <br /> :;�.�44 <br /> NO. �L '._I i .j ;; S DATE <br /> �3�-�-Lp,ivr�3 f).e�� <br /> Service Address Utility Account No. <br /> ,--;*: . <br /> - - Connection Permit Fee ` — -- <br /> Billing Address ___ <br /> �.- , �- = � � , ,� � ' •= \ ; Connection Fee <br /> City, State, Zip ' • ' <br /> __� <br /> Owner (Mortgayor)'� " ' � +•. , `" Total Fee <br /> Billing Name '- <br /> Connection 8y � + r� � `�i� _ �', '. <br /> Address ' t"'r �C^�� 7 ' 1 = Signed " c„scome� <br /> . - . i .._ , ' �- 'i <br /> Phone <br /> DESCRIPTION: <br /> Lot � <br /> Block ; ' <br /> r i i . F: - , ; . .. ! - ;�� , �,1 <br /> Division or Addition - - <br /> $ewer District <br /> Monthly Sewer Service � — <br /> Remarks � ���l �.��.�-' Monthly Sewer Constr. - <br /> �p, ea.�,,,,��1. a3� ��7 3�/'=S�' ' <br /> /j1 -�7—`_ qpproved By -r� - I i �1 ��'� <br /> i <br /> �I Ciry E�g�neer <br /> i�_. `—.'::''L <br /> Issued By _ <br /> Connection By <br /> Inspectiun BY � ��'� <br /> — Date Inspected_���'�� � <br /> � <br /> SEE SKETCH raTTACHED <br />