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i <br /> Pvereft i <br /> �� I <br /> � <br /> City of Everett <br /> i <br /> Engineering Oepartment <br /> Sew�r Application and Permit � <br /> � l� --- <br /> NO. � DATE ' " <br /> Service Address _ _ � Utiliry Account No. <br /> Billiny .Address Connection Permit Fee. <br /> City, State, Zip __ Connection Fee <br /> , Owner (Mortga�or) _ Total Fec_________ _____ <br /> Billing Name _ <br /> Connection By____. _ _ <br /> Address�-- �, / �E r Signed------ ---- --- <br /> c����„„��., <br /> Phone_ <br /> DESCRIPTIGN: <br /> Lot _ <br /> Block_ _ <br /> Divislon or Addition______________.________ <br /> ___ ___ Sewe�r District <br /> Monthly Sewer Service <br /> Remarks: y . _f <br /> Monthly Sewer Constr. _ <br /> (���_�_li.s� �_�,.���'��-!. _ � s..�(.i. �i_. � '< <br /> � S C /�� n � 7 AVPi oved By — - --.— <br /> _ 77 `¢' ..�/2 ` °,� � � ( liftiLs-�Pil I// YeC�f �, Gry Enyinrv•r . <br /> /��_ `. <br /> _.-'_ —_ �StiUt.'d fiY_'___ __'_ . . <br /> — Connechun E3y. -- <br /> -- Inspection By_.4�. �1 ��C�""'��'�- -' _. .. _ <br /> _ --- Datu Insper.ted_.. `��. '� �7� . .. _ <br /> �—�-----_. ._ __._. . ... . � <br /> � � ---. _. __— <br /> SEE SKETCH ATTACHED <br />