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everett � � <br /> , _� � � , <br /> � � ' ��� �, , . <br /> , � <br /> City of Everett <br /> Engineering Department <br /> Sewer Application and Permit <br /> 3 2:; :�4 <br /> N0. _1,0339 DATE <br /> Service Address_�.� ( d �� N� Utility Account No. <br /> Billing Address Connection Permit Fee <br /> , �� • <br /> City, State, Zip `� ' -' � , l Connection Fee <br /> Owner (Mortgagor) ' ' Total Fee_ <br /> Billing Nan��: <br /> Connection By <br /> Address Signed <br /> cuvon,er <br /> Phone <br /> DESCRIPTION: <br /> Lot <br /> Block <br /> Division or Addition �' - � - <br /> � �'� Sewer District <br /> Monthly Sewer Service " <br /> ,, . ,: :.� <br /> Remarks. . �,�t__��, ,. ,. - . .�.,� _ . <br /> Monthly Sewer Constr. <br /> ' �i -zt�v. ^ � �03(,y APProved BY <br /> � <br /> � C�ry Enginecr <br /> — Issued By <br /> Connection By <br /> Inspection By <br /> . <br /> Datelnspected %��% ��� '' _ <br /> .YI <br /> SEESKETCH ATTACHED <br /> � n , <br />