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ever�tt '.�i��� /O� <br />.�'r' y�`Q; � % <br />� �� � <br />City of Everett <br />Engineering Department <br />Sewer A►pplication and Permit <br />N o. .1- lJ � :i � <br />DATE _ <br />�308� <br />Service Address '-'� ��` ' Fj =%' ��'. Utility Account No. <br />Billing Address � � �*�T-�' � ,%'') ,� ' Connection Permit Fee � — <br />City, State, Zip '( ��� �� � '� ��'��� �1�-`� �„ Connection Fee_ — <br />', �O D n <br />Owner (Mortgagor) , �-' /� " <br />''' ' Total Fee <br />Billing Name <br />�/. i -" <br />Connection By — <br />Address ' � <br />oti...,o . � . ' . ._. � -- <br />DESCRIPTION: <br />Lot _ <br />Block_ ' <br />Division or Addition_ <br />iC ' . <br />Signed <br />SEE SI<ETCH ATTACHED <br />I:�!�.-�r',_':�.l�l(��i ! <br />Sewer District ' - ' f� ' "'--- <br />Monthly Sewer Service <br />Monthly Sewer Constr._ <br />Appro��ed By <br />� City Engineer <br />Issued B <br />Connection By <br />Inspection By �� C�''��ti«�'� — <br />Date I nspected��/ �'� — <br />