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� - <br /> %ver�tt <br /> e �� - � �� � ��� =��� � � <br /> I � � i°�� f . <br /> i�' � ! ' /+ <br /> � l�` ' ���.;��,� ;r� <br /> City of Everett <br /> Engineering Department <br /> Sewer �►pplication and Permit <br /> � , ; . <br /> ;� :i;',02 <br /> N0. 1_O � 7 O DATE � � � � " � <br /> r.. <br /> Service Address ' ' Utility Account No. <br /> <. <br /> Billing Address - Connection Permit Fee _ — <br /> City, State, Zip . ' ' , Connection Fee <br /> , :� . <br /> Owner (Mortgagor) ' " Total Fee � <br /> Billing Name " <br /> . : ;<: � % <br /> , Connection By ; - ; <br /> � � i i .; i�j� i / � :l %� . <br /> Address � % Signed ' �`[ ,, ;�,. ;.c• :/ ,`,_ ii,i. <br /> � • � Customer � <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 /> �,��.,... �a-1' aL3 ' acl �_Q�,z_e! y Y9 ' S , P <br /> 7 � <br /> J <br /> Approved By � <br /> n^^ ^ Cily Engincer <br /> 1 f I <br /> Issued By ' <br /> Connection By <br /> Inspection By �� �--���'-«--� <br /> Date I nspected ��`°�� `� __ <br /> J <br /> SEE SKETCH ATTACHED <br /> I NSPECTIi i;'. <br />