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� <br /> e��ereri <br /> � .�� <br /> City of Everett �'� <br /> Engineering Department <br /> Sewer Applicction and Permit <br /> 32475 <br /> N0. G- 0O9� '� DATE . - <br /> Service Address ' Utility Account 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 /> _,,� <br /> Address '` ' �{���'�•'<- Signed <br /> Cusromer <br /> v _ _ . <br /> Phone — —— <br /> DESCRIPTION: <br /> Lot - ` <br /> Block ' � ' <br /> Division or Addition ' <br /> Sewer District <br /> Monthly Sewer Service <br /> Remarks: <br /> _ - - � Monthly Sewer Canstr. <br /> „ ,�. ,. -'%": 1''1 //<. <br /> ti .d-�-&� -vt,.,u-c� n_.a..Qlc•-c._.4. a.�� �-�-..C-' APProved BY , � , ; ,; . _ <br /> (� — — y � City Engineer <br /> fu�= s. <br /> Ca-��- ��1-a-.-T�---�-� � _ Issued By_ . <br /> — -- Connection By <br /> Inspection By k C.�l\c.�a-.� <br /> Date Inspected_� � ' �' � � � — <br /> � , <br /> SEESKEiCH ATTACHED + <br /> � <br /> I' <br /> I <br />