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everett /1 <br />e �� <br />City of Everett <br />Engineering Department <br />; <br />< <� .: , �� <br />� i ; i/� , <br />,,. <br />.. . <br />; �: . <br />Sewer Application and Permit <br />NO. � � L� �� L� v/ DATE _.. _ <br />��;:4�� <br />' �� � Utility Account No. <br />Service Address - <br />E3illing Address _ Connection Permit Fee -" <br />City, State, Zip �- Connection Fee <br />Owner (Mortgagor�_ %" j �� ' � Total Fee <br />Billing Namc " <br />Connection By . 1 � �' �- � i" - i _ r � 1.�- � � <br />�i 6� .� �� C'�-,.': . ^• t('�/: i%.���� ��', '� ����{.�rih!iFli/ .p.. <br />Addf855 ,' � ' � � � �%'!:'>,, 1 , "Sig�Bd_� - Cusmmer <br />� - - I -- <br />..�____ _ _` ,�i . . F.. , <br />, <br />DESCRIPTION: <br />Lot_ . <br />Elock • ! � _ <br />Division or Addition� - <br />SEE SKETCH ATTACHED <br />Sewer District__ <br />Monthly Sewer Servicc <br />Monthly Sewer Canstr <br />ApUroved By ` <br />Ciry Enginccr� <br />ISSUCd B�! <br />Connection By— — <br />Inspection By�-�—�� � <br />Date Inspected���? `/ — <br />