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everen <br /> � . . <br /> i - <br /> City of Everett <br /> Engineering Department <br /> Sewer Application and Permit <br /> . , r�32 <br /> .1 �.. � <br /> N0. ���' � � � DATE <br /> Service Address Utility Account No. <br /> Billing Address ' < < Connection Permit Fee � ' <br /> , <br /> City, State, Zip • � � ' ��/r' Connection Fee �� � - <br /> Owner (Mortgagor) ,� !' �f' Total Fee __ <br /> Billing Name ' ��'v' _ <br /> Connection 8y :i; • <br /> Address ��,'� ' 1�� , :- lj� Signed <br /> c�,,��m�� <br /> Phone --- --- <br /> DESCRIPTION: <br /> Lot <br /> Block==-_— - <br /> Division or Addition___ <br /> Sewer District <br /> Monthly Sewer Service <br /> Remarks: �:'— l:- - l. �t/:. <br /> Monthly Sewer Constr. - <br /> =i� C� v-R / �.� 3G � 5 c� n�.� <br /> APproved By <br /> ., j✓ Ciry Engineer, . <br /> Issued By <br /> -- Connection By _— <br /> Inspection By��7 ��+-�'��-z�+ <br /> Date I nspected ''�d�7 zi <br /> � -- --- <br /> SEESKETCH ATTACHED <br />