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evereH I - � / - . . <br /> � t r <br /> � ,r � y <br /> _ , , <br /> City of Everett <br /> Engineering Depertment � <br /> Sewer Application and Permit <br /> � tiE; F9 <br /> No. �'.01�4 -� DATE � � <br /> Service Address �l � ' ' ' ' ' Utility Account No. � <br /> Billing Address ' � " � Connection Permit Fee <br /> City, State, Zip i ' %� " -�fi� % Connection Fee � ' <br /> Owner (Mortgagor) ' ' %• - Total Fee <br /> Billing Nam� <br /> Connection By ` � - — <br /> _�. _ <br /> Address i r%? 3 Signed <br /> �� , �,- � �— , � Customer <br /> Phone � , � ' <br /> DESCRIPTION: <br /> Lot ' % <br /> Block � ' <br /> Divisio� or Addition �= ,: : =� -•' .'� i � i '� ;',j;:i <br /> Sewer District <br /> /_ Manthly SeH�er Service " <br /> Remarks: ' ; ; c � . -". � - _ <br /> — � Monthly Sewer Constr._ <br /> � <br /> �I�..�_-�`a���.y <br /> Approved By ` � ' �_ '.� <br /> � _ � �.�Q— p City Engineor <br /> N1Grv�� C•�!_1 NO�M . <br /> _ Issued 8y ` ' �!' , <br /> 2�. Ba 0��. �� , SS_��_ — <br /> r <br /> �-- Connection By <br /> In;pection By�F" "L-��� <br /> Dste I nspected. �/ 5/ �j — <br /> � -- <br /> SEESKETCH ATTACHED <br />