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everett <br /> e :.� ��- ����� .� � �. � <br /> , , <br /> , ,, � � , <br /> City of Everett 1�� � . / �� �I � '1�' <br /> Engineering Department �i1' <br /> Sewer Application c+nd Permit 3 ��� �,S <br /> NO. �f O � �- � � DATE _ <br /> Service Address Utility Account No. <br /> Billing Address <br /> j Connection Permit Fee <br /> City,State, Zip__�'� ` ' ' ��, /� '' 1 ' Connection Fee <br /> Owner (Mortgagorl,—F- �"�`�` ' ` � ' �� -? Total Fee -- <br /> i� <br /> Billing Name � `— <br /> . ,�,. - � <br /> Connection By _ --- <br /> AddfeSS _ � '��� SignCd Cusmmcr <br /> Phone — <br /> DESCRIPTION: ^ ,/ <br /> Lot <br /> Block <br /> Division or Addition � ' <br /> Sewer District -- <br /> Manthly Sewer Service <br /> Remarks: i ,-� � ' � ' y <br /> . Monthly Sewer Constr._ <br /> cc.�� .v�.a..D co �� — � ,- <br /> Approved Bv ' � � : ' �� . <br /> J ,Ciry Enyinecr <br /> L+W�11. — c �.^�-�_1� � . <br /> � Issued I3Y -- <br /> C�..�'�» ` 3 � � (�X �o '�Q�. - <br /> l � � a� u�° .Zo �k.:_._ ��.. ."�0 4 � �� �+� ���- Connection BY- ----- <br /> Inspection By—�1�� ' � r�"`c""' — <br /> Datelnspected ? �� ��3— <br /> -- — � � <br /> .� <br /> SEE SKETC{i ATTACHED , <br />