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everett <br /> e �� . : � <br /> City of Everet: <br /> Enoineering Department <br /> Sew�r Application and Permit <br /> �3 �0� <br /> NO. �� � �- � 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 /> Co;nection By_ ` — <br /> Flddress � � t Signed_ <br /> a����m�, <br /> -� = <br /> Phone � }` ' <br /> DESCRIPTION: <br /> Lot <br /> Block <br /> Division or Addition — <br /> Sewer District — <br /> Monthly Sewer Service <br /> Remarks: ' 1 —( — <br /> Monthly Sewer Constr. <br /> `.� -/c) ,a�3.- �i � (J � '� :�c � �LA, . <br /> t� <br /> Approved By � <br /> � �� � �� � „y City Enpinrcr <br /> � � <br /> �L���� :� 1 �1�cA " .�`:-�-' �� Issued By <br /> _C j�_s L��C - C' 0 e_� .�n�r. C"�: G ���c,1�- <br /> ��J <br /> Connection By <br /> i��r� : � � L �_ �a �.� � � <br /> ` Inspection By_ ti� ���c�� �, --� <br /> � � ` . <br /> a T- � rtl, � <br /> / ! i j.i, � <br /> �� ' .� y��� ��._ � Datelnspected % i— <br /> �l L�� <br /> . .� <br /> 7 <br /> SEESKETCH ATTACHED <br />