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� <br />everett ' <br />� <br />City af Everett <br />Engineering Depanment <br />� � i � � r . _ _ <br />i � � � �.2-�. 7`, <br />i�� . . � �=� . <br />Sewer Application and Permit <br />�; , - � <br />NO.•-�-� ��1J <br />DATE - ' <br />Service Address �- Utility Account No. <br />Billing Address Connection Permit Fee "" <br />City, State, Zip � %, � � �, � ' Connection Pee <br />Owner (Mortgagor) - ' - To[al Fee " - <br />. <br />Biiling Name ' '- <br />Connection By '� � <br />Address `" - r ,; �i� <br />Signed t <br />� c�:io���� <br />Phone_ `' -' �'%'%d �/ <br />DESCRIPTIO��: <br />Lot " <br />Block �i `�� <br />r <br />Division or Addition � f `;% _ :J <br />Sewer District <br />Monthly Sewer Service -" <br />Monthly Sewer Constr. - <br />SEESKETCH ATTACHED <br />i r; <br />Approved By - <br />C��y Engmeer <br />Issued B <br />Conni <br />Inspe� <br />�ate I <br />►i <br />