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evercti <br />� ' <br />City of Everett <br />Engineering Depariment <br />Sewer Applization and Permit <br />N0. ��1��)c'i'��� � DATE <br />Service Address Utility Account No. <br />Billing Address Connection Permit Fee <br />City, State, Zip_ Connection Fee <br />Owner (Mortyagor� T�tal Fee � <br />Billiny Name <br />Connection BY __ <br />Address_ � �� ___ Signed_____.__ <br />c��.����„��;- <br />Phone___ <br />DESCRIPTION: <br />Lo[ —=�- i -- <br />Block - ' <br />Division or Addition_ ______. <br />Remarks: <br />Sewer Dis�nct <br />Nonthly Sewer Service <br />IMunihly Sc�.ver Con�rtr..._ _ _ . . <br />-F2.G�.-� _ p�ww 1 � �2 o Z \'� cL� <br />'l � - Approv���l 13v------ <br />, �� i ���i�� � � -- <br />_ illo l�rs� .9-s a� �/-z�- �y _ <br />�i5s���d sy -- _�. _ <br />� <br />- — Connection By_ _ _ _ <br />_ - ----- I Inspection f3Y-- — <br />—J <br />IDatelnspected__. _ <br />v, -- . _ . <br />S[G SKETCH ATTACHED <br />