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cverea <br /> e , <br /> City of Everett <br /> Engineering Oepartment <br /> Sewer Application and Permit <br /> , , , <br /> � � �;:z� -- <br /> N0. .�-�.: `} � �a • DATE � , ' . . <br /> Service Address _ � ' Utility Account No. _ , <br /> - ;, <br /> Billing Address " __ Connection Permit Fee - —J�� __ <br /> City, State, Zip �f= 7 T Connection Fee <br /> �wner (Mortgagor) _� "'F Total Fee <br /> Billing Name � <br /> Corniection By— `' ' '� <br /> Address---.r „ 1 -.' r> ' �' Signed ' _ <br /> c ' ,_ , ��! � _ � Custamer <br /> Phone - ,"� � , . � . . . <br /> DESCRIPTION: <br /> Lot <br /> Block__ ( <br /> Division or Addition � '- <br /> Sewer District � ' .S <br /> — Monthly Sewer Service '-- . <br /> Remarks: C',;;.; . �: ' ,",-� . <br /> Monthly Sewer Constr. <br /> �-C-��� F� � i r 5 o APProved By ' J.'-� % <br /> Gty Engincer� <br /> �—""""� ISSUCCI BY - — __ <br /> Connection By _— _____ <br /> Inspection By—,G����i�ta---� <br /> Date I nspected � �� 7 <br /> .P1 <br /> SEE SKETCH i TTACHED <br /> I�� sl'EC1l(�i�! <br />