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evere!t " " r <br /> e � � �� �� = �� �� �, �,� : <br /> City of Everett <br /> Engineering Department <br /> Sewer Application and Permit <br /> � � i68 <br /> NO. � O � � J .� DATE - -� ' — <br /> Service Address - '-'� Utility Account No. <br /> , . <br /> Billi�g Address Connection Permit Fee - <br /> City, State, Zip - Connection Fee <br /> Owner (Mortgagor) � Total Fea_ <br /> Billing Name <br /> Connection By <br /> /• � �.. _ <br /> Address i�� �' -� ' - " ' ` ' Signed <br /> cus�omcr <br /> . i <br /> Phone — <br /> DESCRIPTION: <br /> Lot � ' <br /> Block <br /> Division or Addition — <br /> Sewer District <br /> , <br /> Monthly Sewer Service <br /> Remarks: -' <br /> Monthly Sewer Constr. <br /> �,�? LI��o-�'c .Q..Q� U ' �i r` <br /> Approved By ' <br /> � � � � � CRy Engmeer <br /> .�- a /Z --s,��a PX � ?r <br /> _,___ Issued 6y <br /> _ — Connection By <br /> — --- Inspectian E3y C���'�"'� — <br /> Date I nspected__��/ 9��`� <br /> :� <br /> SEE SKETCH ATTACHED <br /> � in^� <br />