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everett <br /> � � <br /> City of Everett � � �) 3 O <br /> Fnginecring Oepartment <br /> S�awer Application and Permit <br /> , <br /> N0. .LIi (� .� �� � DATE ' --- --- -- <br /> Service Address �`) 3 C?_ Utility Account Nu. <br /> Billing Address _ Connection Permit Fee <br /> City, State, 2ip %.__ Connection Fee <br /> Owner (Mortgayor�_ ' Total Fee _-- --- <br /> 6illing Name -- <br /> Connection By " -- <br /> . , i . Signed <br /> Address -- - -- �,,,,,,,,,,,, <br /> Phone----- - - - - - - <br /> DFSCRIPTION: <br /> Lot ._- <br /> Block — <br /> Divisian or Addition _— ——_ r -- <br /> Sewer District__ ___--. <br /> _-- — Monthly Sewer Service____-- - <br /> Hemarks: . � , � � � i � � <br /> - Monthly Sewer Gonstr <br /> .�-�, A _ ,C' n1 �--T l.. c <br /> � -- <br /> _' 1 �- vL / — ts- '._�J �c.uti�c,. G ' _ <br /> � 1�y C APProved BY- <br /> CnV Eng�nenr <br /> 2 ���:�^� <br /> - —�- <br /> — Issued BY--- _ __ ._ — <br /> - Conneclion By.__. - -�-- <br /> -- -- - -- Inspection By—�— ' ' `��1`—`�=--- - <br /> -- <br /> c. z j � � <br /> Da�clnspected___ .__— -- -- ----- --- -- <br /> yr---- --- -. . <br /> ------ - _ — - — <br /> SEESKETCH ATTACHED <br />