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everr�t � � , , _ , <br /> � ' , I <br /> City of Everett <br /> Engineering Department <br /> Sewer Applicatoon and Permit 3z4�s <br /> NO. .'l. � �) �.� i'� DATE _ <br /> Service Address /�f v�, Utility Account No. � <br /> . ; <br /> Billing Address '� �i' '� ' ���-G Connection Permit Fee - <br /> City, State, Zip ' % �r � � � �" Connection Fee _ <br /> Owncr (Mortgagor) � � +� � T'I ' -- 'otal Fee " <br /> , <br /> gilling Name '� � � - — <br /> , . � , , <br /> �. <br /> Connection By ' - <br /> ' �i Signed <br /> Address " — ' c,��,�o�„�, <br /> � ` <br /> Phonc � � --�- � -- —. <br /> DESCRIPTION: <br /> Lot_- <br /> Block <br /> Division or Addition � — <br /> SewerDistrict -- -- --- <br /> _� , � <br /> - Monthly Sewer Service '� ' '� `� <br /> Remarks: _ -'�� � ' � Monthly Sewer Constr. — <br /> . ' ( `f'""'.<_ <br /> � . <br /> _� •rCo-�,,,..� _t� (�'� f- `�o� APProved By ; <br /> C�IY En9inccr <br /> �� 'L 5 ,-Q. �. ISSUeCI �y -- <br /> /� � / 3 � a S ,r <br /> �,l)� k. t X�4 `a1�_��- ['B"ti"2 Conneciion BY--- - -� — ---- ---- ----- <br /> � ��- ^ ;��-. <br /> -� �7y°"�` Inspection By '�� ' � '���'u"`-C <br /> Datelrspected_�� �`��� � <br /> — �- <br /> ��--- -- <br /> SEE SI<ETCN ATTACHEG <br /> . <br />