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everett � � � ' ' /_ ,' `i <br /> �. <br /> r�� � ��,P j2�f���j�� <br /> City of Everett 3 Z 2 81 <br /> En�inNrial Oep�rtment <br /> Sevver qptalication and Permit <br /> N0. �-O O 12 ✓ DATE <br /> 86 C�' �j�/f' �� Utility Account No. /y��� T=�L'"f� <br /> Service Address ' ) "'� <br /> i ;: �, : ": .� <br /> . r. c Connection Permit Fee <br /> BillingAddress � �� ` � � ' _-- <br /> - - �/�(j ;'� , • : •% Connection Fee <br /> City.State, Zip ' ='� a � +' <br /> „ , �C�. .� , ) _ <br /> '� " " Total Fee <br /> Owner (Mortgagor►�%`�������� ���"� ��� �— <br /> BillingName � ' ��' "--�-- /��� `�M�— <br /> ' � <br /> y /Y� �-i/ )i �.'• .�; `�- )_— <br /> Cunnection Dy � , <br /> / � ' Signed <br /> '" � ;'^ �. , / � customer <br /> Address �� ---'-- <br /> � r�,- ,� (� <br /> Phone J '�� <br /> DESCRIPTION: . <br /> Lot� <br /> Block - -- �"' �l r ' r � �f <br /> pivision or Addition% ' � � ' ' �� Sewer District <br /> Monthly Sewcr Service <br /> Remarks: � Monthly Sewer Constr_ <br /> ��.. Q ,� �, f ��' �'�.� <br /> —�— _ � � <br /> � – ;'/, ,;, ; ..- � i: , ; <br /> /� C S � ApProv.d BY CitV Enpmeer <br /> ��•=w ' ,� , <br /> Issued By ' — <br /> Connection By <br /> Inspection 8y � � <br /> � <br /> - Date I nspected__�%��-�--- <br /> :� <br /> SEE SKETCH ATTACHED i.;.,f,, , � i,,r� <br />