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everett _ � � `� ��, ' - � - <br /> � �' L <br /> � <br /> � �_,�,.�G,t <br /> V `- - <br /> . � - ,,�; <br /> City of Everett �' �. l,'� <br /> Engineering Department ; <br /> Sewer Application and Permit <br /> � �, r� , <br /> �:.� � � <br /> N0. �Z� 3 4 � DATE — . � 1 <br /> ;, ;. _ <br /> Service Address , ' r ' 'r_! T Utility Account No. <br /> Billing Address � � Connection Permit Fee "'`.+ '"�""C,� <br /> City, State, Zip Connection Fee <br /> ;"c <br /> Owner (Mortgagor) ' r= ;' i Total Fee —'�. - "� <br /> Billing Name <br /> Connection By ' — <br /> Address ," ' Signed �� • <br /> � . • - - Customer <br /> Phone - <br /> DESCRIPTION: <br /> Lot r.. . _ , <br /> Block � � <br /> Division or Addition -.- ! ' .c+': ; / <br /> Sewer District <br /> Remarks: <br /> Ulonthly Sewer Service - -' <br /> Monthly Sewer Constr. -- � <br /> �1 �c,��'' � � C' uJ,�� .2 . ' <br /> � 5 �� � /�� � R�c .np ApProved By - , :-,:c i•i,,� <br /> Ciry Enqinecr <br /> � V <br /> Issued By �_!� <br /> Connecticn By <br /> inspection By h�' ' r �✓^--< �— ' <br /> _ Date Inspected����'� <br /> � _ <br /> SEE SKETCH ATTACHED <br /> ir:,���, ,: ��,i�_, i <br />