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everett <br /> e � �� �r�� ��� - <br /> � � <br /> �, � <br /> City of Everett <br /> Engineering Department <br /> Sewer Application and Permit . � �, �-, ,; <br /> NO. 1 O 2 �. �' � DATE <br /> Service Address - �` Utility Account No. <br /> Billing Address Connection Permit Fee <br /> City, State, Zip -' Connection Fee — <br /> Gwner (Mortgagor) _� Total Fee <br /> Billing Name <br /> Connection By <br /> Address Siyned <br /> a�s�o�„�� <br /> Phone --- --- <br /> DESCRIPTION: <br /> Lot_�-- <br /> Block — <br /> Division or Addition " <br /> Sewer District <br /> Manthly Sewer Service <br /> Remarks: '� ' i; <br /> Monthly Sewer Constr. <br /> /!S�"�� v <br /> , <br /> � � I ��� LZ`� Approved BY <br /> � Ciry Engincer <br /> — Issued By — <br /> Connection By <br /> Inspection By <br /> Date Inspected `'�'`�� 3 <br /> �.,---- <br /> SEE SKETCH ATTACHED <br />