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evered <br /> � ���� � �� <br /> �� i v � l <br /> �l_ ,,/ .� , ��� ' r . <br /> City of Everett <br /> Engineering Department � � '- <br /> Sewer �pplication and Permit <br /> / Jc;JO2 <br /> rvo. �0112 DATE � <br /> Service Address " ' % - ���/= Utility Account No. <br /> Billing Address Connection Permit Fee_ <br /> City, State, Zip _ ' � Connection Fee <br /> Owner (Mortgagor) Total Fee <br /> Billing Name <br /> Connection By <br /> Address " Signed <br /> c����am�� <br /> Phone "j-- ' j ` <br /> 1::SCRIPTI ON: <br /> Lot - . , <br /> Block_ -' <br /> Division or Addition " <br /> Sewer District <br /> Monthly Sewer Service ' <br /> Remarks: <br /> Monthly Sewer Constr. <br /> t <br /> ��� � <br /> Q3�%L ' `n 5�_-9�— � � ,. . , , <br /> a Approved By •� - ' <br /> Ciry Engineer <br /> ISSUC� By �� � � _ <br /> — Connection By <br /> Inspection By—�' �a �(�� l� ^� ___ <br /> / <br /> Date I nspected��2 S�� __ <br /> a <br /> SEE SKETCH ATTACHED <br /> I i�i r<!'EC I l' 'iJ <br />