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� <br />;�. <br />- - F i ' - � � <br />everett J <br />� <br />City of Everett <br />Engineering Department <br />Sewer Application and Permit <br />5�.�:�3 <br />N0. �011�J � DATE �� � -- <br />Service Address_ Utility Account No. — <br />Billing Address_ Connection Permit Fee — <br />City, State, Zip Connection Fee � <br />Owner (Mortgagor) r ' Total Fee <br />Billing Name <br />Connection By <br />Address ' Signed <br />customer <br />P�lO11C " -.' ' ' ' <br />DESCRIPTION: <br />Lot <br />Black <br />Division or Addition <br />J <br />SEESKETCH ATTACHED <br />Suwer District__ <br />Monthly Sewer Service <br />Monthly Sewer Constr <br />Approved By <br />Ciry Engliw�r <br />Issued Bv —__ <br />Connection 8y <br />Inspectian By � "',-�� <br />Date Inspected l 's-.j <br />