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_ . . . . ♦.. . + . <br /> everett � _ <br /> � 1 . <br /> ,' 1 �J� , <br /> ��� <br /> City of Everett / <br /> Engineering Depr�• .�ent � ; <br /> Sevver Application and Permit <br /> ��472 <br /> NO. aOO � j � D�TE <br /> 7S�ZD �Ji/)/t,C' ,U �r_ <br /> Service Address Utility Account No. <br /> Billing Address Connection Permit Fee <br /> City, State, Zip • 2"tE �� � <br /> — Connection Fee� <br /> Owner (Mortgagor) __ Total Fee <br /> Billing Name <br /> Connection By <br /> Address Signed <br /> Customer — <br /> Phone <br /> DESCRIPTION: <br /> Lo: <br /> Block � <br /> Division or Addition <br /> — Sewer District <br /> Remarks: <br /> , Monthly Sewer Service <br /> Monthly Sewer Cunstr. - <br /> `( `r��,...,%-` � ,, ��'��?' -P� 3 i �� <br /> Approved By <br /> ��� � � � ���_W Ci1V Enginccr <br /> — Issued By <br /> Connection By _ <br /> ,n � <br /> Irispection By—N v ,G ?niw–� <br /> Date Inspected �"? ' S � 7 y- <br /> s� <br /> SEE SKETCH ATTACHED <br /> , . ;.�-, , <br />