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evetett <br />,� <br />City of Everett <br />Engineering �epartment <br />, . ,-, <br />' n C'%��'�l <br />� :,�>,�'_; <br />,_ <br />,� . <br />Sewer A�plication and Permit <br />✓ I _.__.--- <br />NO. �L�.� 1 y I DATE — — <br />Service Address� Utility Account No. <br />Billing Address Connection Permit Fee ` — <br />City, State, Zip '� Connection i�e i� �T 2E�iJ� <br />Owner (Mortgagor) Total Fe^ <br />Billing Name <br />Connection By --- <br />Phane <br />DESCRIPTION: <br />Lot <br />Block <br />Division or Addition_ <br />Remarks: <br />r <br />Cl�ul� Cl3 "o <br />� ��1 . �� <br />� <br />SEE SI<ETCH ATTACHED <br />- Signed <br />c��s��,,,�, <br />Sewer Distric;__ <br />Monthly Sewer Service <br />Monthly Sewer Constr <br />Approved By <br />Ciry Enginccr <br />�SSU�CI BY -- — <br />Connection By <br />Inspection By�'�-<w"�"'�-�� <br />i <br />Datc l nspccted_ �; '- �- <br />