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everett <br /> �� — � �� �L���-� _ � <br /> j�_, ,.��•c� <br /> e � . <br /> City of Everett <br /> Engineering Oepartment ��'J �0 <br /> Sewer Application and Permit <br /> NO. �O O `� � DATE ` <br /> Service Address � - Utiliry Account No. <br /> - � Connection Permit Fee <br /> Billing Address _ <br /> -' Connection Fee <br /> City, State, Zip � <br /> + � - Total Fee <br /> Owner IMortgagorl ' " <br /> Billing Name <br /> Connection By � ' ��� , ���" � � ��-/f� - <br /> , �6 '] �J �-. ' '� ' : Signed <br /> AC�dfeSS �� Ur � � Cusmmer <br /> Phone , -' <br /> DESCRIPTION: <br /> Lot - � <br /> Block_. ' <br /> Division or Addition <br /> Sewer District <br /> Monthly Sewer Service � <br /> Remarks: � = �- � t• '�= : ' '' y' Monthly Sewer Constr. <br /> � .� ..# - - r:�� - - <br /> /7 � � � <br /> , �o,i,b- ,.-i .�C`-ru,�.-. APProved By c��v e�en,�« <br /> � ` . a-e-� ,GLLn..t - <br /> �.�< <br /> �7 - Issued BY � — <br /> .n��.1: �t''_ n w,. ' <br /> C011il@CUOl1 BY <br /> Inspection By � � �'�""`� <br /> Date Inspected � ,����� `� — -� <br /> :HJ <br /> SEESKETCH ATTACHED <br />