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evergtt � ,� � ^ - . . .. <br /> .��� � v - �-- �-� _� <br /> •.� � � �' �I _ �{ <br /> , �l�i'"''' �' %;�r��;�`, <br /> City of Everett f�� 1 ��,� <br /> %- <br /> Engineering Department <br /> Sewer Application and Permit <br /> ���. ss <br /> NO. �.� 2 � 6 DATE - <br /> Service Address Utility Account No. <br /> Billing Address Connection Perm�t Fee <br /> City, State, Zip_ Connection Fee <br /> Owner (Mortgagor) Total Fee__ <br /> Billing Name_ <br /> Connection By ' ' '� <br /> Address_ ' � ' �/c� . Signed <br /> Customer <br /> Phone <br /> DESCRIPTION: <br /> Lot :� <br /> Block <br /> Division or Addition <br /> Sewer District <br /> Remarks: <br /> - Monthly Setver Service <br /> Monthly Sewer Constr. <br /> �/J 4�.t ti,.. ts.� ' c....w6 _ <br /> �-- �t I , Approved By <br /> ��3_ , y �n e. a� a� bl� Ciry Engineer <br /> ��—`m�C—� Issued By <br /> �3 3� ` ,� � ' <br /> �� '_ Connection By _ <br /> Inspection By �1/ '/=C.�:'-Y'�.---� <br /> Date Inspected ��3��� 3 <br /> s� <br /> SEESKETCH ATTACHED <br /> i��,�.��;_;_� i�,,1 <br />