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_ . , i <br /> everett <br /> ) <br /> � I' f <br /> I <br /> \ <br /> City of Everett <br /> Engineering Department <br /> 5ewer i4pplication and Permit <br /> � V �'ll �V <br /> N0. <LO _L. _�_ I DATE - � — <br /> Sei oice Address Utility Account No._. <br /> ,.. ... <br /> � <br /> Billing Address " _ —.— Connection Permit Fee - <br /> City, State, Zip Connection Fee – <br /> O�.vner (Mortgagur) Total Fee <br /> Billing Name_ <br /> Connection By " <br /> e -- Sii ned — <br /> ,q(�(�f@5$ " � ' ' � � Cusiomcr <br /> Phone —-------- <br /> DESCRIPTION: <br /> Lot - <br /> Block � ' <br /> Division or Addition -- --- <br /> Sewer District — <br /> �' Monthly Sewer Service <br /> Reinarks: / �w�/' <br /> / l <br /> � —(�—`=—�(� � !-� rn Monthly Sewer ConsV. <br /> 2�('� O..CJW �4.��V.�C2.�.r.2�. C.w��bL- �O �� <br /> //�� c�� ���Q �^ <br /> �_{„�_l <br /> V � <br /> —p Approved C3y — <br /> � � _ ���s.�� � � / ���� CIry Enginenr <br /> � <br /> .�___–!_3__��y Issued By --- <br /> Connection By <br /> Inspection By ���-"� �(�"�'�`� <br /> Date Inspected!! �� � �— — <br /> � <br /> � --- <br /> SEE SI<ETCH ATTACHED <br />� <br /> - - - - �s_ <br />