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. / _ <br /> everglt . � �/p5 `� <br /> � � ' ! . � <br /> City of Everett <br /> Engineering Dep�rtment <br /> Sewer Application and Permit <br /> ,, � .. <br /> , r 't� <br /> NO. �l-� �JU --- <br /> .3.J �U <br /> DATE <br /> , <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 /> Cusromer <br /> Phone <br /> DESCRIPTION: <br /> lot <br /> Block <br /> Division or Addition � <br /> Sewer District <br /> ✓ <br /> S C7 <br /> — Monthly Sewer Service Z e _ <br /> Remarks: • � ; <br /> Monthly Sewer Constr.�� �'D <br /> �/ �, <br /> i � ��""''1 7r G •� � ���/� -�� � <br /> Approved By ' <br /> ��' ' � � � � � � `�_� � � CitV Engmecr <br /> � Issued By <br /> — Connection By <br /> Inspection By�s/��'��"�«�*`� <br /> Date Inspected / /��%� <br /> � <br /> SEESKEiCH ATTACHED <br /> . <br />