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everett <br /> :e - fUo <br /> � <br /> �� �5 <br /> City of Everett <br /> Enginr:ring Department <br /> Sewer Application and Permit � <br /> :i �:a55 <br /> NO. :.LO � `� � � DATE � � — <br /> Service Address J�- � �1� S i ' `-)�:!� /f U� Utility Account No. � t <br /> Billing Address _ Connection Permit Fee <br /> City, State, Zip ' Connection Fee <br /> Owner �Mortgagor) � lbtal Fee <br /> 8illing Name <br /> Connection By <br /> Address Signed <br /> c����om« <br /> Phone — <br /> DESCRIPTION: <br /> Lot <br /> Block �i <br /> Division or Addition <br /> Sewer District <br /> Monthly Sewer Service <br /> Remarks: � <br /> Monthly Sewer Constr. <br /> / !„ � �. �a� �u � <br /> �'i�J <br /> /� Approved [3y_ <br /> �'/ � �' C U e Ciry Engmerr <br /> J <br /> Y Issued By <br /> L{�,,.ti� <br /> — Connectian By— <br /> Inspection By �t -�"''� --� <br /> Date lrspected��/�� > <br /> ZI <br /> SEE SKETCH ATTACHED <br />