Laserfiche WebLink
u <br />everett <br />e <br />City of Everett <br />Engineering Department <br />z9-5 <br />, ��� � <br />�� <br />I � � �� , �� � r �� r�.��. <br />Sewer Application and Permit <br />� NQ �t. O �i H 7 DATE i� -_ ; < , _ ',,' ,� <br />` . <br />� , _ <br />' Service Address � <br />� <br />j Billing Address - <br />i CitY, State, 7_ip ' �' /- � <br />I � <br />� Owner (Mortgagor) .. <br />I <br />Billing Name ' " <br />' Connection By <br />Phone <br />DESCRIPTION: <br />Lot <br />Block � <br />Division or Addition. <br />Utility Account No. <br />Connection Permit Fee <br />Connection Fee <br />Total Fee__ -- <br />Signed <br />SEESKETCH ATTACHED <br />IN5PECTIOPd <br />Sewer District <br />Monthly Sewer Service_ <br />Monthly Sewer Constr._ <br />Approved By '' <br />Cily Engincer <br />Issued Bv _ __ - �.____ <br />Connection By <br />Inspection By � �-�`.-..-a-.--� <br />Date Inspected ����/ �'-! <br />