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, _ <br /> eveiett , .�' ` <br /> � �/ <br /> �� /:. %`� . , <br /> e ��-� � �� � ������ � <br /> City of Everett <br /> Engineering Uepartment <br /> Sewer Application and Permit ., .� :-, �, �, <br /> Jv �. ^ f <br /> rvo. �� ��9 3 DATE / ��/ _ � / <br /> Service Address '���2 _�'/,L�r �T Utility Account No. <br /> Billing Address Connection Permit Fee <br /> City, State, Zip Connection Fee <br /> Owner (IVlortgagor) Total Fee " <br /> Billing Name <br /> Connection By � ' <br /> Address Signed <br /> - ' � Cuslamcr ' <br /> Phone �I <br /> DESCRIPTION� <br /> I_ot�_ <br /> � Block�.Q_,�L_ <br /> Division or Addition_ <br /> Sewer District <br /> Monthly Sewer Service <br /> R emarl<s: <br /> Monthly Sewer Constr. <br /> .�S � ~� / � �-�1 S � ✓'�` APProved By <br /> City Engineer <br /> � a I� ' � Issued By <br /> Connection By <br /> Inspec[ion By � �--�-e��it —� <br /> Date Inspected��'� � <br /> :F� <br /> SEESKETCH ATTACHED <br /> - IfJSPECTP 'i; <br />