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evercri <br /> �� _ , <br /> }.� .�«� „��.� <br /> City of Everett ��G- �`.11 <br /> �_ <br /> Engineering Department <br /> Sewer Application and Permit � �- : � �� <br /> N0. ��.1� 2 j I DATE � —'� �- �� <br /> ���2� s//J/iy <br /> Service Address Utility Account No. <br /> Billing Address Connection Permit Fee <br /> City, State, Zip_ Connection Fee_ <br /> Owner (Mortgagor) _ _ Total Fee <br /> Billing Name <br /> Connection By <br /> Address_ ' ' ' Signed <br /> a�s�om�� <br /> Phone <br /> DESCRIPTION: <br /> Lot <br /> Block_. <br /> Division or Addition <br /> Sewer District_ _—_--_— — <br /> , Manthly Sewer Service_ <br /> Remarks: • � <br /> .j/:' <br /> Monthly Sewer Constr. <br /> .C' "' �' i l <br /> ,1rc��. U.�„on.�.,�g v- ^Z �W : <br /> � <br /> Approved By <br /> � / � ^ — City Engineer <br /> ) �2 ��0�n� <br /> ��t_ <br /> — Issued By <br /> _ Connection By <br /> Inspection8y �'f, '�""'����J <br /> Date Inspected 5 y? �j <br /> � -- <br /> SEESKETCH ATTACHED <br />