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evc�rett <br /> � � <br /> � <br /> City uf Everett <br /> Engineering Department . <br /> Sewer i4ppiieation and Per°met <br /> L' n . �) � <br /> ^ " �. <br /> NO.�:�. � _, � . DATE ---- <br /> , <br /> Service Address %=" � UtiliTy Account No. <br /> Billing Address ����� Connection Permit Fee <br /> City, State, Zip �`� ' ' + Connection Fee <br /> Owner (Mortgagor) _ Total Fee <br /> Billing Name _ <br /> Connection By ��' - <br /> Address ' -%%` ' Signed ___ <br /> cus�omcr <br /> Phone — —_ <br /> DESCRIPTION: <br /> L ot <br /> Block <br /> Division or Addition_ _ <br /> Sewer District_ <br /> _----- � Monthly Sewer Service_/� •�'� _ <br /> Remarks: : i = � ��.;.:' ,� � ;r;;' .� � � <br /> Monthly Sewer Cc�nstr.__�L •!-S <br /> _�"��„v� r. �: .,���-f�,�:_ , <br /> -� � `�Z`"� APProved By— — <br /> a�v e�,-��„��� <br /> _ -' GC S ` ' `� . � Issued By ---- — <br /> ---- — Connection By— — <br /> Inspection By—'� -��� - <br /> Date Inspected�_'� `i �r___ _ <br /> _�7 — <br /> SrE SI<ETCH ATTACHED <br />