Laserfiche WebLink
ev,e7eh <br />�e <br />City of Everett <br />Engineering Department <br />Sewer Application and Permit <br />N0. ��O O � � � DATE '� I� <br />Service Address i =�`� ' � " � � � Utility Account No. - <br />Biliing Address �' � Connection Permit Fee '"—' <br />City, State, Zip Connection Fee <br />Owner (Mortgagor) ' ' ?otal Fee <br />Billing Name <br />ConnectionBy � % � ''�'�' <br />Address � ` ' ! t Y � � � � Signed " <br />Cusiomcr <br />Phone <br />DESCRIPTION: <br />Lot <br />Biock <br />Division or Addition 1 '� ' <br />Remarks: � <br />' Ir � <br />Sewer District <br />Monthly Sewer Service <br />'i�-T/ O� <br />Monthly Sewer Constr <br />— � ,< <br />! <br />:l C,� _/,�,.a�tr.J — <br />/ _ — <br />G•1-.< <br />; <br />.. . . .. .— <br />SEE SKETCH ATTACHED <br />� APproved BY - =' � r� <br />City Enginccr <br />Issued By <br />Connection By <br />� <br />Inspection By - <br />Da[e Inspected <br />I;..t;�� . ... <br />