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everett <br /> � , <br /> � <br /> City of Everett � <br /> Engineering Department <br /> S�ewer A,pplicat6on and Pc�mit <br /> ,., <br /> J i. : �. <br /> -, <br /> NO. �,4: : �4u DATE �� � ' � — <br /> Service Address Utility Account No. <br /> Billing Address Connection Permit Fee <br /> City, State, Zip _ Connection Fee <br /> Owner (Mortgagor) Total Fee <br /> , <br /> Billing Name <br /> Connection By <br /> Address '��' Signed <br /> c��s�o�„�:; <br /> Phone_ ---. <br /> UESCRIPTiON: <br /> Lot <br /> Block j <br /> Division or Addition_� - ' ' ,f� <br /> Sewec District__, _ <br /> ----- - 5� <br /> �.lontnly Sewer Ser:iice ' <br /> Remarks: ': . " . <br /> - �jJ„�� ��Ly Monthly Sewer Const;. � � �s <br /> !�w <br /> � r <br /> ��L�w.+.�(� G �� `c,r���— �i'�X �l�t�?�'�/ APProved By. <br /> City EnBinecr <br /> �� l�G' � S � ���.Q� � .,�-c. "^"",.� iLrti�-� Issued By - — <br /> — Connection By---.-__— <br /> I nspection �'��u-�=��"'�_ <br /> Date I nspected� �� _��_. <br /> �_ ___—_ _ <br /> SEESKETCH ATTACHED <br /> . <br />