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everen <br /> e :L�, . <br /> ���- �zi-� `� ,: <br /> City of Everett ��� � . ' <br /> Engineering Department <br /> Sewer Application and Permit <br /> 3N��34 <br /> N0. �. U � �-_ � DATE _ <br /> Service Address ' Utility Account No. <br /> Billing Address Connection Permit Fee <br /> City, State, Zip � % ' Connectio� Fee <br /> Owner (Mortgagor) Total Fee <br /> Billing Name ^ � <br /> Connection By <br /> Address - _ Signed_ <br /> c�s�o«,�� <br /> Phane_ <br /> DESCRIPTION: <br /> Lot <br /> Block ' -�. . <br /> Division or Addition. <br /> Sewer Distiict _ _ <br /> Monthly Sewer Service <br /> Remarks: �"r - : <br /> Monthly Sewer Constr. <br /> ���e��,, _�r� G,j- w P-�. 1 8� � S � <br /> Approved By_ c�rv e�9�o���, <br /> ��i (�- � .,B-R.Q.�.,� <br /> Issued By <br /> Connection By — <br /> Inspection By �� 'Ji{�- �-n-� <br /> Date Inspected S�/� <br /> � <br /> SEESKETCH ATTACHED <br />