Laserfiche WebLink
everett <br />� <br />City of Everett <br />Engi�eering Oepartment <br />I � �� L `1 - � <br />-1 <br />( <br />Sewer Application and Permit <br />N0. ��. U-L O�i / DATE - <br />Service Address �� �Z �� r�� ^� L L Utility Account No._ <br />Billing Address <br />Connection Permit Fee <br />City, State, Zip_ Connection Fee <br />Owner (Mortgagor) // Total Fee <br />Billing Name <br />Connection By <br />, - _ Signed <br />Address a�vom�� <br />, . <br />Phone ' - <br />DESCRI?TION: <br />Lot <br />Block — <br />Division or Addition ' <br />e <br />Sewer Distnct <br />Monthly Sewer Service <br />Monthly Sewer Constr <br />� <br />SEE SKETCH ATTACHED <br />Approved By �- ' i <br />Ciry Engineer � <br />Is�ucd 6Y- -- -- - - <br />Gonnaction BY-- - - - — <br />Inspection By � �'��°�io.� <br />Date Inspected / � - �5 " � Z — <br />