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everett �( � I <br /> �� � <br /> �� � . ��'�'�' %`/ <br /> City of Everett i �_�/ ,� � <br /> Engineering Department j � .< . ' �/ <br /> Se�rer ����ication cand Permit <br /> �� �: ,, � <br /> : �� , <br /> N0. --. '� I `:"� DATE — I <br /> Service Address Utility Account No. - <br /> Billiny Address Connection Permit Fee <br /> City, State, Zip Conmction Fee <br /> Owner (Mortgagor) _ Total Fee <br /> Billing Name <br /> Connection By _ <br /> Address_ - Signed <br /> - a�,�����,.� — <br /> Phone <br /> DESCRIPTION: <br /> Lot <br /> Blocl< <br /> Division or Addition __ <br /> _ Sewer District <br /> Nionthly Sewer Service <br /> Remarks: <br /> Monthly Sewer Constr. <br /> �A� ING �— <br /> � Approved By <br /> _ '� � O Ci1Y Engincer <br /> � �0 <br /> - - Issued By <br /> Connection By <br /> i . — <br /> � � u'^i` I�OT� l.1/SPL�G7T� <br /> Inspection ey�5 �F !l — � =-7—`�— <br /> Date Inspected <br /> i <br /> To <br /> SEE SI<ETCH ATTACHED <br />