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e�erett <br /> ..� �� ' �� � <br /> City of Everett � <br /> Engineering Department <br /> Sewer Applicntion and Permit I <br /> ? , i � , ,; �� � <br /> NO.�O � :� DATE _ ' <br /> Service Address _ Utiliry Account No._ <br /> Bil"ing Address Connection Permit Fee <br /> Cit��, State, Zip -% Co;inection Fee <br /> Owner (Mortgagor) � -i otal Fee. <br /> Billing Name <br /> Connection By _ <br /> Address _ Signed _ <br /> � Cusmmer <br /> Phone <br /> DESCRIPTION: <br /> Lot - �� � <br /> Block_ `� <br /> Division or Addition - <br /> Sewer District <br /> �O <br /> Monthly Sewer Service <br /> Remarks: ' ' ` <br /> �/�� �yL� Monthly Sewer Constr. / � �� <br /> — Approved By <br /> Ciry Engincer <br /> ISSUECJ BY . <br /> -- — Connection By <br /> InspectionBy �` �^� Lu//o /i�,✓ <br /> ' _ Date Inspec.ed •Y� r� � 3 _ <br /> .i�7 <br /> SEESKETCH ATTACHED <br /> �7: .t'L'C�i If,;.i <br /> -. - <br />