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. —,._____ <br /> �everett ' • � - I <br /> ,3 <br /> , � ,� y � , �-� <br /> � ' �. <br /> City of Everett <br /> Engineering Oepartment �,{ <br />� Sewer i4ppli�ation and Permit � <br /> �� �: _ ;a3 <br /> rvo."�:0 � "18 <br /> DATE <br /> Service Address Utility Account No. <br /> Billing Address Connection ?ermit Fee <br /> Ciry, State, Zip Connection Fee <br /> p Owner (Mortyagor)__ Total Fee <br /> Billing Name <br /> Cennectian By__ <br /> Address_ Signed <br /> ci,torncr <br /> Phone <br /> i — <br /> DESCRIPTION: <br /> Lat <br /> Bluck <br /> Division or Addition <br />'' -- <br />" SCWC'f �ISl.'ICI <br /> Remarks: <br /> Monthly Sewer Service <br /> Monthly Sewer Constr. <br /> P c <br /> ��e� P � `11� � 1�. APf�roved BY— <br /> Gty Enginccr <br /> t �_ � <br /> IIssued By -------- <br /> � <br /> �� �� Conn�ction By _ <br /> Inspection By—Q�,b'—C.���.� <br /> — D�tc Inspected_`O�� /� "--- — <br /> L <br /> `, ---- <br /> SEESKETCH ATTACHED <br />