Laserfiche WebLink
everen <br />� <br />City of Everett <br />Engineering Department <br />Sewer Application and Permit <br />�1 �, -- � DATE _ - <br />NO.:�..,,1�' - <br />Service Address ' Utility Account No. - ' <br />Billing Address ___ Connection Permit Fee — <br />City, State, Zip "" Connection Fee <br />: ! __ <br />Owner (Mortgagor) � 1 ';. -- � : _ ' ' ' Total Fee <br />Billing Name � - <br />Connection By 1�,= r, ,' f i!_ ! f��= <br />Address `� �^ `�� ' L�: �!t'f=�T 7'" Signed_ ' <br />CUsiomcr <br />Phune � '-' <br />DESCRIPTION: <br />Lat <br />Block_ <br />Division or Addition ' � <br />Sewer District,_ �J <br />Monthly Sewer Service.__ __ <br />Remarks: 5.. l. �, :, � . r. <br />�Sonthl�� Sm�,�m� Const�_ .._ _ _______ <br />'��? n _� _.ir��cn.a — --- - --- — _ <br />�Tl' A,:i. �. -i �,pprovcd By <br />C�ry Enyinc..�r <br />Issued By `rl <br />Connection By <br />'nspection By '��"�^��""t"'� <br />Date Inspected_ �� '_ _ __'' __ <br />:� <br />SEE SKETCH ATl"ACHED <br />