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everett � _ 7 c� _ �� <br /> � �-- .: <br /> City of Everett <br /> Engineering Department <br /> Sewer Application and Permit <br /> ,/ ���f67 <br /> N0. �_ I� CJ � J 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 /> Connection By <br /> Address Signed <br /> Custamer <br /> Phone � , <br /> r—� �-�{/`� � r-� � �.�' <br /> DESCRIPTIUN: ��.> " <br /> Lot _ , ?��' Z�'" � <br /> t � <br /> Block �' ` <br /> Division or Addition ' /T�+' � ✓ �' � ' ,� �� <br /> Sewer District <br /> Monthly Sewer Service <br /> Remarks: � r .� i ", i /�%`��� �% ' / � � �'� <br /> Monthly Sewer Constr.__ <br /> �,# ,. C�6'-c.�r� t G � �y/ 'o� ��z� �� <br /> r <br /> 11 P�. 4 • I� ��- l�� Approved By <br /> . �� � /) Gty E�gineer <br /> �j.n� a.Q '� _�R-Pt0 " <br /> . � <br /> ���QC�C,S � �� � �uu,� Iss�ed By ' " <br /> � � <br /> Connectian By <br /> Inspection By �1��-��'��"^, ✓ — <br /> Date Inspected_� �t� _�--- _ <br /> , � <br /> 7— --- <br /> SEESKETCH ATTACHED <br />