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._ � _ , :-_ . <br /> everetl _ <br /> � � ) \ J / <br /> � � L> � <br /> City of Everett ' � � � <br /> Engineering Department " <br /> Sewer Application and Permit <br /> � zs�� s <br /> rvo. �� 18 6 / DATE = � <br /> , <br /> Service Address -- i � - " �' � , . Utility Account No. <br /> Billing Address % % % _ Connection Permit Fee " <br /> City, State, Zip .' r r�., :'. ;- 1 ' � Connection Fee �°T ��4vi�� <br /> F- _ <br /> Owner (Mortgagor� '� Total Fee " <br /> � <br /> Billing Name � ' ` .. , <br /> % — <br /> __ _. �: ' . , . ' <br /> ConnectionBy � " .:'+ <br /> Address � � •.� [ "' - Signed \ __ �✓ :_.r:z <br /> Customer <br /> Phone � - � <br /> DESCRIPTION: <br /> Lot <br /> Biock " _ � <br /> Division or Addition f i �- �,`� . ' <br /> Sewer District <br /> Monthly Sewer Service --�� � <br /> Remarks: (� � /;:'�-i �>;.�� . ;._, <br /> Monthly Sewer Constr. ��. <br /> y " G�-�.., � G "��d � S� <br /> Approved By ,._ L., ti rJ <br /> �� � C P �� � � � Ciry Engineer <br /> Issued By t <br /> Connection By <br /> Inspection By �'/%-<����---- <br /> Datr. lnspected 3��d'�73 <br /> � <br /> SEESKETCH ATTACHED <br /> I,-�;SPECI�Ii��I�! <br />