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CVCFEit �." � % , -� ? � _ C <br />+� - <br />� � ) <br />City of Everett <br />Engineering Department <br />Sewer Application and Permit <br />N0. �OOI.H � DATE `' ; ` <br />/ ,/ <br />Service Address ��2 ��/�f .CGY'��Z' Utility Account No._ <br />i� <br />Billing Address � __ Canner,tion Permit Fee --'------= <br />City, State, 2ip �- '�" Connec?ion Fee <br />Owner (Mortgagor) Total Fee_ � <br />Billing Name _ <br />Connection By _ -�f _ <br />Address _ _ Signed `' <br />Cusromer <br />Phone <br />DESCRIPTION: ' " <br />Lot _ <br />Block <br />Division or Addition <br />SEE SKETCH ATTACHED <br />IiiiP"7: � !i;E <br />Sewer District__ <br />Monthly Se�ver Service <br />Monthly Sewer Constr <br />Approved By % <br />City Engineer � <br />Issued Bv_ I: r` <br />Connection By _ _ <br />Inspection By " <br />Date I nspected � � <br />