Laserfiche WebLink
everet� I w <br /> e � �� � _ <br /> � <br /> City of Everett � <br /> Engineering Departme it <br /> Sewer i�,pplication and P'ermit ('� /� <br /> V � � �1 •,1 <br /> N0. ^ �� � 5 `� DATE ' — <br /> i <br /> Service Address � " /�% =' Utility Ar.count Na_ -- <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 /> ~����-' Cuslomer <br /> Phone_ " <br /> DESCRIPTION: <br /> Lot_ <br /> Block <br /> Division or Addition ' <br /> Sewer District <br /> Monthly Sewer Service _ <br /> Remarks: '.' <br /> Monthly Sewer Constr. <br /> �i��c-� /o J� � Yl dl n� � "� �7 � � � � APProved [3y ' <br /> Ti <br /> Ciry En9ine�:r <br /> �'^"� �SSUBC) BY � —__.—__ . <br /> — Connection By — <br /> �nspection By � ti'�'"'`'"--' <br /> Date Inspected z�" � '� <br /> J <br /> SEE SKETCH ATTACHED „ <br />