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evere� <br /> � � � � � �'� � � � <br /> City of Everett <br /> Engineering Department <br /> Sewer Applicration and Perrx�i# <br /> J�;bSb <br /> NO. .L U J O H DATE :_ r <br /> Service Address � ' "� �� '± �`�� ' /%.`r Utility Acccunt No. <br /> Billing Address `� ` � �= Connection Permit Fee_ <br /> City, State, Zip � ' , ` ,l ' -,'-' ` ','%': . ' Connection Fe� , ' ' '- , <br /> � , . <br /> Owner (Mortgagor) ' ' ' `f°% n � � T �<' := Total Fee <br /> Billing Name = <br /> Connection By � "t= ' '. <br /> Address f ' Signed � <br /> Custamer <br /> Phone - <br /> DESCRIPTION: <br /> Lot <br /> � <br /> B�a�k - �. <br /> Division or Addition <br /> Sewer District '-' <br /> Monthly Sewer Service � <br /> Remarks: i. i - , , - . <br /> Monthly Sewer Constr. <br /> i <br /> ' C�z.-,,o '�F <. �',�.� hi!,� .Q..• <br /> ��� �'S � � S�..._1.�. �- . <br /> Approved By ; '',`;� -, ' _� <br /> Ciry Engmeer <br /> Issued By _ <br /> Connection By— <br /> Inspection By ��/2�e��. �-..� <br /> �Date I nspected �/�' �� 3 <br /> —� <br /> :� <br /> SEE SKETCH ATTACHED <br /> . iFiSF'ECi i0i�! <br /> 1 <br /> �_ ___ __ _.. ...,sn.:v�_"_ ��_ � <br />