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everett / � i� _� <br /> � � �� , <br /> . � U�� � � ��, <br /> / 7 <br /> , r�, �:F _ t i,, i <br /> , ,(i/�' ��' , <br /> City of Everett � � <br /> Engineering Department <br /> '� Sewer Application and Permit � � � � ,� <br /> I N0. �O 5�� DATE <br /> Service Address Utility Account No. <br /> Billing Address '- Connection Permit Fee <br /> City, State, Zip ' ' '� Connection Fee <br /> pwner (Mortgagor) <br /> � Total Fee <br /> I Billing Name <br /> Connection By ' <br /> �. AddfESS ' � � . - Sig�18C1 . _ . ,..� Cdstomer� ��� `-- <br /> Phone <br /> DESCRIPTION: <br /> Lot ' �' <br /> Block � <br /> Division or Addition <br /> Sewer District <br /> Monthly Sewer Service " <br /> Remarks: Monthly Sewer Constr. <br /> y^'Cv,,,,,,, � � " „a` � � ApProved By . ; <br /> CitV Ehginccr•. <br /> '_. , 1 <br /> �.'��G �. � � Issued By ' <br /> Connection BY <br /> �nspectionBY '� ""^'" - ��``� <br /> Date I nspected �/��/� y <br /> :�1 <br /> SEE SKETCH ATTACHED I;,;.;r, :;�I��;' <br />