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everett <br /> � i . � � .�' <br /> t � , - �.. . <br /> City of Everett . <br /> Engineering Uepartment <br /> Sewer Application and Permit �3��� <br /> �1 , � , ; , � � <br /> Np, �y� 4l) �i DATE <br /> Service Address _ Utility Account No. <br /> ., <br /> Bi!Iing Addres� � '� i'` _ Connection Permit Fee , "� <br /> City, State, Zip ' �-��_� � Connectic� Fee <br /> Owner (Mortgagor) ` ` f �%� � Total Fee - — <br /> Billing Name ' �t= <br /> Connection By '�- <br /> Address ' ' � � ' ' ���`� Signed <br /> Customcr <br /> Phone -- <br /> DESCRIPTION: <br /> Lot <br /> Blor.k ; ,, <br /> Division or Addition �' ' <br /> ,, . . Sewer District _ <br /> Monthly Sewer Service <br /> Remarks: ,' ,�,� -'�l� ,'/��-,- -- . <br /> Monthly Sewer Constr. - <br /> � • -y F:% �5�`�� � <br /> y" �uJr.� C�c,,,-',ac.� � . <br /> . i .� ; , � � , . <br /> Approved By <br /> � Gry Enginccr <br /> a 3__�� <br /> Issued By -- <br /> Connection By ------- ---- <br /> Inspection By ��i�-� ��7'�`=-� <br /> Date l nspected / ' � � <br /> � <br /> SEE SKETCH ATTACHED <br />