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everett <br /> � <br /> City of Everett <br /> Engineering Department <br /> Sewer Applica�ian and Permit <br /> .� �::� �s <br /> N0. -� C� --�'� � DATE — <br /> Service Address ;Utility Accour.' No. <br /> Billing Addre;s _ Connection Permit Fee <br /> City, State, Zip Connection Fee <br /> Owner (Mortgagor)_ Total Fee <br /> Billing Narrme <br /> Connection By <br /> Address ' Signed <br /> . �-� customer <br /> � Phone ' � � <br /> DESCRIPTION: <br /> �ot _ <br /> Block_ _ � <br /> Division or Additicn � <br /> Sewer District —. -- <br /> -- Monthly Sewer Service — -- — <br /> Remarks: ' <br /> Monthly Sewer Constr. — <br /> ., � <br /> y c�:-Y.�-� 7a� "�-�'�.�' f�°Y �' ��y--__ <br /> � � Approved By <br /> 4 � ���SC S ! J-.�C�-�' ,1¢�t.�3_f. � •�..—a.� � Ciry Enginecr <br /> � <br /> , ISSUB(I BY __ <br /> _ — Connection By <br /> Inspec[ion By .,t����� � �`�'��`"`� <br /> Datelnspected ����/� 3 — <br /> VI <br /> SEE SKETCH ATTACHED _ <br /> �. ,_,� ��.C�f1 �P. <br />