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ever�tl� <br /> � ' , <br /> _ i _ <br /> City of Everett ' <br /> Engineering Department <br /> Sewer Application and Permit <br /> _ ,{ <br /> L r e. +� b <br /> .t. r� <br /> `l 'l �_ <br /> N0. ' �-�JJ .J �: DATE <br /> Service Address __ Utility .Account No. <br /> Billing Address � Connecticn Permit Fee _ <br /> City, State, Zip � 'Connection Fee - <br /> Ovaner (Mortgagorl � Total Fee _ <br /> Billing Name <br /> Connection By " • ""-'' � ' ` <br /> Address -- :' i: .- _ , : Signed _ . <br /> ,.�... <br /> c�,:camc� � <br /> Phone__ _ <br /> DESCRIP I ION: <br /> Lot <br /> Block .��' I/ <br /> Division or Addition -i ' •-V ' <br /> Sewer District <br /> 5� <br /> Monthly Sewer Service -- _ <br /> Remarks , , 7,=-� <br /> 7 /UK (5r(/L y Monthly Sewer Constr. /� /s <br /> � � � <br /> „ <br /> C-�'^.-, '�ej !; ,z�' J �-- `�--,� <br /> Apprcved By_ <br /> � ' City Enyinecr <br /> ,, � �SSUCCI BY _._—_ <br /> ��c� c � c� -�'� � <br /> - — Connection By -- <br /> ---- — Inspection By ��l ;���'"�—� — - <br /> Date I nspected_ � ' ' % ' � <br /> � — <br /> SEE SKETCH ATTACHED <br />