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everett � - : ` - : � <br /> � ��� <br /> �,� <br /> � <br /> City of Everett <br /> Engineering Department <br /> Sewer Application and Permit <br /> ��G� S <br /> NO. ��O 1. 7 � DATE - <br /> Service Address �- � � � � Utility Account No. <br /> Billing Address Connection Permit Fee �� <br /> City, State, Zip Connection Fee ���� ��i <br /> Owner (Mortgagorj Total Fee - - - _ <br /> Billing Name � <br /> Connecr.ion By " . — <br /> Address � Signed <br /> - Custamcr <br /> Phone - " � <br /> DESCRIPTION: <br /> Lot <br /> Block <br /> Division or Addition <br /> ; <br /> Sewer District <br /> — Mon[hly Sewer Service _ <br /> Remarks: <br /> Monthly Sewer Constr. <br /> �d..O�o..�_n , v� ��-�-w�-� ' �%c�. <br /> ll � � '_ <br /> � Approved By � � � <br /> City Enqincer <br /> � 3S � c1� {�1�y�� .LJ /�c�p� Issued By — <br /> �. . <br /> Connection By <br /> I nspection By �� 'r�-`"�T-��--' <br /> Date lnspected � � � 3 <br /> :� <br /> SEESKETCH ATTACHED <br /> I�d<:PECTIOP' <br />