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everctt <br /> � _ <br /> City of Everett I <br /> Engineering Uepartment <br /> Sev�ver Applieeation an� °errsr�it � <br /> � <, �� ;� � <br /> N0. ��'- � J _ � DATE _ -- — <br /> Servica Address Jtility Account No. _— — <br /> Billing Address_ Connection Permit Fee_ <br /> Ciry, State, Zip _ Connection Fee <br /> Owner (Mortgagor) To:�l Fee_ <br /> 3illing Name <br /> Connection By -- <br /> Addrass Siyned__ —— <br /> c��:i�,��,��� <br /> Phone--- -- ---- --- <br /> DESCRIPTION: <br /> Lat <br /> Blo;:k <br /> Division or Addition__- -- <br /> Sewer District___ <br /> Monthly Sewer Service <br /> Remarks: • �' <br /> Monthly Sewer CansYr._ — <br /> '��C�^,-,ti�L•z' ' <br /> E;�ca.,� <br /> 1 � <br /> 1. �L'�a�—� Approved By - <br /> Ci�Y Enyina�i <br /> �{ -�� '� C� C S�� .�.... 1` ,o • � ,� 7� {�ic..f„�-.-`- I ssued By — <br /> .�G_ ' <br /> Connection By <br /> Inspr.r.tion By y �� � "� `��"� — <br /> / , <br /> Date l nspected��'� ' ' -- <br /> — -- <br /> SEE SKETCH ATTACHED <br />