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�evere� <br /> � I <br /> ' - `� <br /> City of Everett <br /> Engineering Oepartment <br /> Sewer Application and �'�rrr�it <br /> , : . <br /> V a. t, t Y <br /> N0.',-- L �'� '� DATE - , <br /> Service Address Utility Account No. <br /> 8illing Address =' Cannection Permit Fee �'` � <br /> City, State, Zip •' :onnection Fee <br /> Owner (Mortgagor) - Total Fee <br /> Billing Name_ � _ <br /> Connection By_ ' �Y*=,'_�.�' - ' <br /> Address 'r� -�' � "" � � Signed_ <br /> Cusmmer <br /> Phone -- <br /> DESCRIPTION: <br /> Lot _ <br /> Block �r <br /> Division or Addition �=' _ � <br /> Sewer District_ <br /> Monthly Sewer Service Z�� <br /> Pemarks: <br /> (/�J/< � G�Y Monthly Sewer Constr. �i �-S _ <br /> L��('s-r�.�. �., lv � 1 aa' �/�� - ..-.>.-..L.�� <br /> 3 'r�-seo — Flpproved QY � - <br /> Gty Engincer <br /> �`'� �G' C -' �" � Issued By <br /> ��- f` 7r_��j•• � �� �i 5��� �./'o <br /> — Connection By— <br /> C <br /> Inspection By � • ����+-u-�' <br /> Date Inspec[ed i1 � i � __7 > <br /> J <br /> SEE SK[TCH ATTACHED <br /> � <br /> �a� <br />