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everett - � - <br /> � I / <br /> , �_ ) <br /> '1 <br /> City of Everett � <br /> Enpineerinp Department � <br /> Sewer Application cnd Permit <br /> 324R5 <br /> N0. �O Z O 4 / DATE .L-• '=<-- - �7 �- <br /> ' / y�� U <br /> Service Address�7'70 9f /4 ' � ' - ' _. <br /> Utiliry Account Nu. <br /> Billing Address— :-9 P ;^"" Connection Permit Fee___,=l"' %`� <br /> City, State, Zip— ' ; �� � , _ <br /> Connection Fee - - <br /> Owner (Mortgagor�_ ' ^ � Total Fee "�"'" <br /> Billing Name - '- �" <br /> ConnectionBy_• 7' � •�i ;',;� <br /> Address -. / . 4, r J. 7�- . �_ ! � � _._ � . <br /> . - r Signed <br /> Cwtomer <br /> Phone_ �,—/ � <br /> DESCRIPTIQIV: � " <br /> Lot � � <br /> Block_ _.> <br /> Division or Addition ' '%�%+ � 'i"; -' s <br /> Sewer District <br /> flemarks: - r- . , —� ' Monthly Sewer Service <br /> 1 . r ti r� ("..: � ,L_ <br /> ---� <br /> �� / Monthly Sewer Constr. <br /> �Y�a � � <br /> o . Approved By f/ , 'i L,:= ci�t. '�J � <br /> c��y e�o�naa. <br /> n ,�- , <br /> Issued By ' _ � '�--- <br /> :— _ <br /> kcJ f, <br /> Connection By <br /> Inspection By �1'��-v`�—�Si,.✓ <br /> Datelnspected_���� � <br /> :� <br /> SEE SKETCH ATTACHED <br /> INSPfC I IUN <br />