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everett ' <br /> e - - . � � .- .- - . <br /> � � , <br /> `� ;;�:: ; � . <br /> ;� ,1 . r <br /> City of Everett <br /> Engineeriag Department <br /> Sewer Application and Permit � <br /> � �i _�. '7� <br /> . . , , . <br /> N0. ',�' 04 �J �i DATE � , � <br /> Service Address � '" ` ' Utility Account No. <br /> ;� <br /> Billing Address Connec'ion Permit Fee - <br /> City,State, ZiP _ - Connection Fee — <br /> ' ; t' , ' , To.al Fee - � <br /> O�vner (Mortgagor) - <br /> ..a .-«_-=--_—=_- - - -<- -• <br /> Billing Name � ' �-`�'�''����'�" ' '' .'- . <br /> Connectian By � ' '•` ' F h: ���` ! �- , <br /> f`�r � _.'", i`' <br /> Address ' �J ' ' ' ' �� Signed <br /> / , , <br /> Cusmmcr <br /> Phone " � <br /> DESCRIPTION: <br /> Lot <br /> Block � `' -' <br /> Division or Addition " ' ' ' � ' - <br /> , F . <br /> � �� Sewer District_ . <br /> i' � ; � �/, . - �-- <br /> Monthly Sewer Service <br /> Remarks: _ <br /> Monthly Sewer Constr._ "' <br /> G,.,,,,�,�L1 -2 s � /�l d �' � Y1 � ✓ �_P-�� <br /> _=77-� •� .? : , : ; r ,; <br /> Approved By � ' - <br /> T � n • , An Citv Engineer�• <br /> ��N � <br /> Iss�ed f3y -- <br /> i <br /> Connection BY---- ----. — - <br /> , Inspection By—.�� - <br /> e Date Inspected_����?-3 - <br /> :k7 <br /> SEESKETCH ATTACHED � , ,. <br /> � <br />