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e'veren <br /> e <br /> City of Everett / <br /> Engineering Department <br /> Sewer Application and Permit <br /> 3z�ti� <br /> N0. !1 O G :� u DATE _ � — <br /> s �, t�� �-� � . <br /> Service Address Utility Acc^unt No. <br /> Billing Address Connection Permit Fee <br /> City, State, Zip Connection Fce — <br /> Owner (Mortgagor) Tota� Fee <br /> Billing Name � <br /> Connection By <br /> Address_ '- . ` Signed �— <br /> Cu;tomer <br /> Phone_ ` — <br /> DESCRIPTION: <br /> Lot <br /> Block � <br /> Division or Addition__ ' <br /> Sewer District _ <br /> — Monthly Sewer Service_ <br /> Remarks: <br /> - — Monthly Se•.ver Constr. <br /> . . � .;' <br /> y�C' l_c ��E�aa—�l�'� G�c¢ � - A roved B <br /> 'c'"""'..�. PP Y <br /> c��v e�,e„��,� <br /> L_J�+���� � �C"J-r.� e -�'�"'e� a�'^ Issued By , <br /> _ Connection Bv <br /> --- Inspection By��• �«��� lu "� <br /> Date Inspected /�3'�7'— <br /> :Yl <br /> SEESKETCH ATTACHED <br /> urr ' <br />} <br />