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everett <br /> � <br /> i - <br /> City of Everett <br /> Engineering Oepartment <br /> cd•�,or ,�nhl�«tion and Permit <br /> .i� .. ... . -rr•----- - - <br /> V F, <br /> :iUJ <br /> N0. =:'J J G L' DATE � _ <br /> Service Address Utility Account No. <br /> Billing Address Connection Permit Fee __ ._ _ <br /> City, State, Zip _ Conner.tion Fee____. <br /> Owner (Mortgagor) Total Fee_ <br /> Billing Name �� <br /> Connection By_ _ ' <br /> Address ' Siyned_ <br /> � . . Custnm^r <br /> Phone --- <br /> DESCRIPTION: <br /> Lnt / <br /> Block_ �� <br /> Division or Addition - <br /> Sewer District <br /> -O <br /> - Monthly Sewer Service ��s� <br /> Remarks: � � � �S <br /> Vy Monthly Sewer Constr. / � <br /> � � <br /> —! ., L.-^-�-, 7 c " c_x t�.%�" � � �<,._�7 <br /> �'� Approved By <br /> aw e��������� <br /> '-I " ��C�v-05 � a ��: .�.• La �n �n� R-��--- ' Issued By — <br /> - Connection By _ -- <br /> Inspection By ���wL`-=----� <br /> Date Inspected ' r <br /> J <br /> SEE SKETCH ATTAC�iED <br />