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everen <br /> e � � �����:�� �- <br /> City of Everett <br /> Engineering Department <br /> Sewer Application and Permit ���.7� <br /> .,; � -. -� � -. <br /> NO. �-� J ��_ DATE • <br /> � _ ._ __ � �,`�� ,'.G �--'�=� ! l' �- F�� <br /> "` � Utility Account No. <br /> Service Address -' �'' � ' ' <br /> _' , ,:,^. Y I ' �J _ � <br /> Billing Address � " '7 � Conne�tion Permit Fae <br /> City, State, Zip ' ` � �"1 Connection Fee <br /> Uwner (Mortgagor) <br /> r ." �- �-% Total Fee - <br /> Billing Name ' '�" <br /> �.:;;_ ,< - _ <br /> Connection BY -'t _ <br /> , i � , r . . _ . <br /> '-r > ,-ltC—r =- Signed <br /> A(jdfCSS � Cusromer <br /> Phone — <br /> DESCRIPTION: <br /> r <br /> Lot_ <br /> ; <br /> 91ock ' <br /> Division or Addition ' <br /> Sewer District_ <br /> --- Monthly Sewer Service <br /> Remarks: _ /) -i"C� ���f '���"� �- MonthlySewerConstr. <br /> �_ ;ff,V i l,�l c . ,--J %, �� " <br /> , � :., '-��:= '�-T =it/ c ._ ,� . ;� ��..�i i .. �,,.,.. <br /> — � <br /> �; ; �;i' :, r= '! -' ApProved By . <br /> •" CitV Engmecr , <br /> L°� S �CX.t-o �,� 'Gr"`'� Iss�ed By � , <br /> (�__7f�F�7��� ^v� � Connection BY — <br /> Inspection By��//�� ��`'�a"� <br /> � � ^ Date Inspected F' � Z � <br /> � <br /> SEE SKETCH P:TTACHED i , .,. <br /> � • <br />