Laserfiche WebLink
eveiett <br />� <br />City of Everett <br />Engineering Department <br />- I - __ �-; - s <br />L` ^ <br />Sewer Application and Permit <br />vo. �' 0114 DATE <br />Service Address ys.3 � �A�/.i <br />Billing Addre;s ' _ <br />City, State, Zip =5 <br />Owner (Mortgagor) <br />Billing Name <br />Connection Bv— _ . <br />Address___' , <br />Phone <br />UESCRIPTION: <br />Lot �' <br />Block <br />Division or Addition � _ _ • <br />Utility Account No. <br />Connection Permit f <br />Connection Fee_ <br />Total Fee <br />Signed _ <br />cu:tomci <br />SEE SKETCH ATTACHEu <br />I'SSf',:,.. ; I�1iV <br />Sewer Distric: <br />Mon:hly Sewer Servicf <br />�lonthly Sewer Con;tr <br />Approved By ' <br />City En�inecr <br />ISSUCd <br />Connection By <br />Inspection By �� ���--� <br />Date I nspected �'Z � � � �- _ <br />