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% <br /> everett �, � ')���� <br /> � q �(�•� r <br /> i!:j �� <br /> �"�. � C�� /�: )�� � .rtQ" <br /> City of Everett <br /> Engineering Department <br /> Sewer Applicction and Permit <br /> '� � 114 <br /> NO. �� 2 .L 7 � DATE ' <br /> Service Address Utility Accour�t No._ <br /> Billing Address_ Connection Permit Fee <br /> City, State, Zip _ Connection Fee_ <br /> Owner (Mortgagor) Total Fee _ __ <br /> Billing Name <br /> Connection By <br /> Address Signed <br /> a�:iom�, <br /> Phone ' <br /> DESCRIPTION: <br /> Lot <br /> Block <br /> Division or Addition ___ <br /> _ Sewer District__ _ <br /> Monthly Sewer Service _ <br /> R emark s <br /> Monthly Sewer Cocstr, ____ <br /> •" '�--�l.s�1•._u. �- ti ' n �s o��—L L����1� ' <br /> ,n�P�o��d ey ;l. � -� <br /> i <br /> �� City Enginrer <br /> Issued By__ <br /> — Connection By _ <br /> Inspection By '�' ���-�_��-«-� <br /> Date Ins�ected_`__�:"� '7j <br /> � ---- -- -.._ _ <br /> .b] <br /> SEE SI<ETCH ATTACHED <br />