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evcrett - <br />� i r <br />{� ' ; � ��l <br />� � � 5� <br />� �� <br />City of Everett I <br />Engineering Department <br />S�wer Application and Permit <br />h0. � O 2 .�_ � � DATE <br />Service Address ' _ , Utility Account No.. <br />Billing Address Connection Perrait F <br />City, State, ZiP � � Connection Fee_ <br />Owner (Mortgagor�_ ' ' _� Total Fee <br />Biliinq Name <br />Connection By .— --- <br />Address " Signed _ <br />Phane <br />DESCRIPTION: <br />Lot <br />Block_ <br />Division or Addition " <br />Remarks: <br />'� � �! a> <br />y� �C'G C's <br />r <br />, <br />SEE SI<ETCH ATTACHED <br />c <br />i <br />X <br />Sewer District <br />Monthly Sewer Service - "- <br />Monthly Sewer Constc _ <br />Approved By ' <br />C'rty Enginccr <br />Issued By <br />Connection By <br />Inspection Ry �, �'tx'ts"�`�� <br />i /.. <br />Datelnspected '>- '`s �.' — <br />e <br />