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everett -" ' ' <br /> � <br /> City of Evere•tt <br /> Engineering Uepartment 3 z 3� � <br /> Sev�eir Application and �ermit <br /> N0. :L � O ;} 1�' DATE � � � <br /> Service Address, Utility Account No..�- 3=f. �=P `�' <br /> Biiling Address_ Connection Permit Fee � <br /> City, State, Zip Connection Fee <br /> Owner (M��rtgagor�_ Total Fee <br /> Billing Name <br /> Connection By ' _ <br /> Address _ Signed <br /> .. ' Cusiamer <br /> Phone <br /> DESCRIPTION: <br /> Lot_ <br /> 81ock <br /> Division or Addition_ � <br /> Sewer District <br /> — Monthly Sewer Service <br /> Remarks: , <br /> Monthly Sewer Constr. <br /> �� C-Ci✓t'27l LC . •i t . � ��rX � �� ��� <br /> � r. �R � j y— , Approved By <br /> �l` e ,�. 'eL.4�-( ...LQ�A-��.� `Y � CitVEnginccr <br /> � C-�.�+�_ l_i�..�.,. <br /> Issued Qy <br /> Connection By <br /> Inspectian By � (� <br /> Date Inspected �� ��7 7 L <br /> i <br /> .YI <br /> SEESKETCH ATTACHED <br /> i. ,,.i <br /> r� �<:..... ,�,;/. . ._ <br />