Laserfiche WebLink
1 1 � , ' <br />�_ <br />� <br />everen �T� � � � �"� i <br />��� �� i�/ <br />� � � . � �, � ,I' <br />- ,��;. - <br />City of Everett � �, �; r !- <br />Engineering Department � <br />SE wer Application and Permit <br />N0. � ,_ DATE . <br />� <br />� ':' . <br />Service Address - � ' <br />Billing Address � <br />City, Siate, Zip , - <br />pwner (Mortgagor) ' <br />Biiling �Jame —' <br />Connection 3y <br />Address ' ' `' 'J <br />Phone — <br />CESCRIPTION: <br />Lot <br />Block <br />Division or Additicn ' <br />Utility Accou�t No.. <br />Connection Permit F <br />Connection Fee_ <br />Total Fee <br />Signed <br />-�—=----- <br />Sewer District — <br />"�lonthly Sewer Service_ <br />�lonthly Sewer Constr. -- <br />0 <br />SEESKETCH ATTACHED <br />L�P(JfOVOd BY ���� Fngineer <br />ISSUCtl Ci <br />Connection By <br />/7 � <br />Inspection By Q`� c_ ?� i'J <br />Date Inspected -� � � � <br />