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everetl � ` � _ �l <br /> e . ;;. <br /> City of Everett <br /> Engineering Oepartment <br /> Sewer Application and Permit <br /> 3�;5 .15 <br /> NO. i1 �� 1 :- � DATC ' ' <br /> ;ervice Address � - Utility Account No. <br /> Billing Address Connection Permit Fee <br /> City,State, Zip Connection Fee <br /> Owner (Mortgar�or) � • � : ' _ Total Fee ' _ <br /> Billing Name__ <br /> Connection By - �' ' _ <br /> Address J ' � - •_� Signed � <br /> Cus�omcr <br /> Phone ' <br /> DESCRIPTION: <br /> Lot ' ' _ <br /> Block • <br /> Division or Addition ' ' <br /> Sewer District <br /> — Monthly Sewer Service_ <br /> Remarks: - r_ <br /> ; i ;; , 1 I., ._ • ^ , Mon[hly Sewer Constr. -- _ <br /> - � <br /> �.y12�a—.��—q��l Lf — -- Approved By <br /> � Ciiy En9�ncer <br /> �LL'_��cu�� /.2/.l"�7/" �-"� Issued By_ <br /> r p �� <br /> -- Connec[ion By <br /> Inspection By_ � - �af�c� <br /> Date I nspected � � 5� 7 <br /> �— -- <br /> SEE SKETCH ATT!',CHED <br /> .�...��i-..II(iiV <br />