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I <br /> �� _ �_ . � _. <br /> everett <br /> � <br /> City of Everett <br /> Engineering Oepartment <br /> Sewer Applicction and Permit <br /> ��:�2 i <br /> NO. -'..� ' �_ .- b DATE — <br /> Service Address _ Utility Account Na <br /> Billing Address ��- Connection Permit Fee ' _. _ � <br /> City, State, Zip___ � Connection Fee__ - <br /> Owner IMortga�or) � — Total Fee- _- - -- - - - - - ---- <br /> Billing Name --- <br /> Connection By_ "% � - <br /> Address r ��� Signed_ -- - — <br /> Customer <br /> Phone - - - -- ----- <br /> DESCRIPTION: <br /> Lat_ _ <br /> B lock__�._ <br /> Division or Addition ; "' � ' ------ <br /> Sewer District_ — - <br /> �%`� Monthly Sewe:Service_ --- <br /> Remarks: ,. : . � �' ,1j , � � ,," <br /> — Monthly Sewer Constr. <br /> - <br /> _ Approved By <br /> r n n� C�itV En4inecr <br /> g.Q.�- �-". a�./,__�,.Rr_ -r,-r <br /> /� '�`� Ca�+�.�.e-c.�/ y�.�� �a.c, v-��._� Issued 8y ' � - - <br /> n� (�, � ��.^�/C.-CA't .-T/.a-r� � <br /> —L«a�L—^'""� <br /> ��,_����% - — Connection By <br /> -- Insp=ction By /�'�e�"x"^� <br /> Date Inspected�^` i — <br /> 7 --- <br /> SEE SKETCH ATTACHED <br />