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, <br /> �__, l -r f _ � � ' � <br /> everett <br /> � C - � - � ��- � <br /> City of Everett ��J 6 5 <br /> Engineering Oepartment <br /> Sewer Applic�ation and Permit <br /> NO. .t.�_) O '� �' DATE - . <br /> Servire Address � Utility Accoun[ No. 7 " <br /> Billing Address Connection Permit Fee <br /> City, State, Zip Connection Fee ` ' - <br /> Owner (Mortgagnr) ' '' �' Total Fee <br /> J <br /> Billing N�me_ <br /> Connection By '� ` � r '' ` >' <br /> Address �,' . ' ' '� � Signed - <br /> cuvomer <br /> Phone -% - . - � ��: <br /> DESCRI?TION: <br /> Lot - <br /> Block <br /> . �_. ;� : -r' -- �t [ ; i <br /> D�vision or Addition � �' <br /> Sewer District '� <br /> . Monthly Sewer Service - <br /> Remarks: :; _: ,; , , -_ �_ . , - - ;-'• �' ;_'-_ <br /> Monthly Sewer Constr. ` <br /> " ' 7 <br /> ��--�'.c�t�.n,��" G.r , .�'�j�' � . _��. . . . <br /> 7 <br /> : ., . .' .,1 - 1.._ <br /> ` Approved By • <br /> �9 //"� ^ � � � Ciry Enginccr•� <br /> C' Y ^�c. •'J / I . � /�� . <br /> Issued By r��� <br /> Connection By <br /> InspectionBy �- �T�-���`"`�� ' <br /> Datelnspected /v����7 � ✓ <br /> J <br /> SEE SKETCH ATTACHED <br /> INSP[CllOi:! <br /> �^ <br /> -•. . <br />