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I <br /> „ / ,C,� <br /> , �i, •, <br /> evereit � � G� �;, , Fi/ ;-����;, 5 <br /> � • / � � " ` <br /> City of Everett <br /> Engineering Department <br /> �ewer Ap�lication and Permit <br /> ,.�� `�i �J 1 � •-� :: f;i <br /> NO. DATE - " <br /> , �� . , r,� <br /> �_ . . ,-, , , _ -_ -- - <br /> Service Address Utility Account No. <br /> Billing Address_ � Connection Permit Fee -- <br /> City, State, Zip _ Connection Fce_.__ <br /> Owner (Mortgagor) _ Total R'�_ - <br /> Billing Name <br /> Connection By <br /> Add ess _ -r Signad <br /> � Customer — <br /> Phone � <br /> UESCRiPTION: <br /> Lot_____ <br /> Elock____ <br /> Division or Additian <br /> —____-- Sewer District <br /> — -- Monthly Sewer Service_ <br /> Remarks: — <br /> �� y��s �� �Z�� 7� Il9onthly Sewer Constr. __ <br /> - — -- �� <br /> -- — Approved By �.' % <br /> Ciry Enpmcer <br /> — Issued By _ __ <br /> ConnectionBy___ ____ <br /> Inspection By _ _ <br /> Datelnspected <br /> �_____.—_—_.---_ <br /> SEE SKETCfi ATTACHED <br />