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evere� � • ; _, <br /> _� ` i _�` ' f , . <br /> e �� �� � - � � �� � , <br /> f' .L�'. <br /> �i.- <br /> City of Everett <br /> Engineering Department <br /> 5ewer Application and Permit <br /> 3313 � <br /> rvo.� 0438 � DATE , _ - . <br /> Service Address '`' ' % + Utility Account No. <br /> � <br /> Billing Address Connection Permit Fee � <br /> ' City, State, Zip ' � � ' Connection Fae - <br /> Owner (Mortgagor) " Total Fee _ - <br /> Billing Name <br /> Connection By • � �� <br /> Address -;`� ' Y Signed <br /> Customer <br /> Phone � -i. � <br /> DESCRIPTI ON: <br /> Lot <br /> Block _ <br /> Division or Additien � j ' � ��4' "" <br /> • Sewer District <br /> Monthly Sewer Service -� <br /> Remarks: <br /> fJlonthly Sewer Constr. <br /> � ��9,e�I � vr//� � � . <br /> Approved By � � �, � <br /> . Ciry Englneer <br /> Issued By _ - - <br /> Cc nnection By <br /> Inspection By � �'��==--- <br /> Date Inspected��i ��?`�. <br /> � <br /> SEE SKETCH ATTACHED <br /> � ��.1cPEC�I(lf� <br />