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ever��t �-- <br /> t J <br /> � , ��.� / `• I �y- . <br /> , '� :'" � ; �i i <br /> Ciiy of Everett � <br /> Engineering Oepartment <br /> Sewe� Application and Permit <br /> " %2 <br /> v ::, ,� <br /> :L; U3OZ DATE � <br /> NO.�• —, <br /> Service Address - � - " �/ Utility Account No. <br /> Billing Address ` '�� _ Connection Permit Fee <br /> �� <br /> City, State, Zip '� 1 - Connection Fee � — <br /> Gwner ((dortgagor) ' - - Total Fee_ - <br /> Biliin� Name � <br /> Conm�ction By <br /> � � <br /> Addiess _ Signed <br /> . � � Cuswmer <br /> Phone_ ' � ' — — <br /> DESCRIPTI��N: <br /> �o� ; -f <br /> Block _ � <br /> Division or Addi;ion !' ' "' —' � ' <br /> Sewer District _ <br /> . � <br /> Monthly Sewer Service � <br /> Remark,: , , ___� - <br /> Monthly Sewer Constr. <br /> i " � 6''. � <br /> � < £ ��� 3/� � <br /> '- 7� �'-`Q-u'� Approved By <br /> . Ciry Engincer <br /> i �) <br /> � � � C � '�� . 4 • �SSII@C� B�/ <br /> ' _. — Connection By— <br /> }c <br /> InspectionE3y �✓�'uG'`�l"`� <br /> Date Inspected �/2<��3 <br /> I '. <br /> J <br /> SEE SKETI;i-1 ATTACHED �NSP[CTIO� <br />