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everett <br /> � <br /> City of Everett <br /> Engineering Department <br /> Severer Application and Permit <br /> ,, , <br /> �,:�4 � <br /> N0. ;�- �� � -i (:, DA7E � - � -- <br /> r <br /> J <br /> . _�.._._.- <br /> Service Address � �- �' �- -n Utility Account No._ — <br /> . ., <br /> _ ' ----_ , <br /> Billing Address Connection Permit Fee - -- <br /> � <br /> _ _ �. -- -- - <br /> City, State, Zip_� � ` ; �� � � �t �`-. �' +- � ', Connection Fee - — <br /> Ow�er (Mortgagor) ` �' ' � �_ Total Fee — <br /> F3illing Name, � ` " <br /> Connection By - �-�y t.' �• , , � "- <br /> Address • r'(Li�"� 7 •'�. �- Signed _ <br /> c��:���„�„ <br /> Phone --- <br /> DESCRIPTION: <br /> Lot_: <br /> Block <br /> Division or Addition <br /> Sew:r District _ <br /> — vlonthly Sewer Service <br /> Remarks: � .;='• >=''i=�i �'.<�, <br /> -- Monthly Sewer Constr. — <br /> ��c��g,, a��°�o� /��2 � YJ !'9 <br /> � q <br /> � � ` Cc�r� / �a G�-�v�'' � Approved By ---- <br /> cuv e�����„���� <br /> Cc¢...�,�,.:�7:JI -wv�'.� 33 / 7 �� � Issued By _ _ — — <br /> Connection By <br /> Inspection By��'��'�^� <br /> - �_ � ✓ <br /> Datelnspected /� '; ' /-'----------- <br /> — - �—;- <br /> J <br /> SEESKETCH ATTACHED <br /> � <br />