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. . . <br /> everztl <br /> � /�_ 1 ; ' , " ��� I <br /> 75 � <br /> City of Everett I � 7 � <br /> Engineering Department <br /> Sewer Applicat�on and Permit . <br /> .7 � :. + :? <br /> NO. ��-� �� -�- � OATE � <br /> Service Address '�-- Utility Account No. - � -' " <br /> Billing Address �- � Connection Permit Fee � <br /> City, State, Zip � � �� �' '� ,� Connection Fee - <br /> Owner (�lortgagor)_ ' Total Fee___ _ _ <br /> Billing Name__ <br /> Connection By + '� —_ <br /> Address_ : � _ ,:.-� , ,. ` Siyned-- � - <br /> - . a::iomm — <br /> Phone --- _`— -- - -- <br /> DESCRIPTION: <br /> Lot <br /> Block_ <br /> Division or Addition_ _ <br /> Sewer District !" <br /> Monthly Sewer Service <br /> Remarks: i :�:�-r� iir , . . . . , . . . <br /> � �� = v � Monthly Sewer Constc _ <br /> . 7, . <br /> Approved By _ <br /> r- .� �/ C�ry Engineer <br /> Issued By <br /> �� de � . - <br /> Connection Ry <br /> Inspecton By � �--��� <br /> Date Inspected � �I��__ _ <br /> � - — — <br /> SEESKETCH ATTACHED <br />