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everefl � _ <br /> � <br /> City of Everett <br /> Engineering Department II <br /> Sewer Application and Permit <br /> � ;::�s2 <br /> Np �_�_C 1 �r � DATE _ <br /> Service Address _-- Utility Account No.__ <br /> Billing Address_ Connection Permit Fee <br /> CitY, State, Zip i __ Conne.:�ion Fee_ <br /> Owner (Mortgagor) - Total Fee_ <br /> Billing Name ` <br /> Connection By � ' ' <br /> Address f Signed — <br /> . a�s�o���� <br /> Phone —_—_-- <br /> DESCRIPTION: <br /> Lot <br /> Block __ <br /> Division or Addition — _ .-- <br /> Sewer District _ <br /> — Monthly Sewer Service � <br /> r�emarks: , ,;;. 1�, ._`- <br /> — '"� Mnnthly Sewer Constr. <br /> � �(�'e`v'c"t E�a�`'- <br /> � � � <br /> ppp — ^ � I I /� � APProved By , r _ <br /> A/� G�N-1 �l/�W COrCx-L. CitvEnginccr <br /> 0 � <br /> Issued By ___ — <br /> — � <br /> Connection By— --- - <br /> 0,- <br /> : � � '� — <br /> � i � Inspection By <<' " �' tiG���� <br /> Date Inspected ` �S �/-' '� <br /> _ ! <br /> � --- <br /> SEE SI<ETCH ATTACHED <br />