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I <br /> everetl I <br /> . � <br /> City of Everett <br /> Engineering Department <br /> Sewer Applia:�tio� and Permit ; ;: E;�� <br /> , �- <br /> NO. L� i 1 �� :� DATF. � — - --- — <br /> .; <br /> .. , , , , , `, . <br /> ""LQ� ' Utility Account Wa. <br /> Service Address_: " •-' "�'=`""=— — <br /> Billing Address_ _—__r. — Connection Permit Fee <br /> � <br /> City, State, Zip__.��Ti �' � ' Connection Fee_ ' - <br /> Owner (Mortgagor) � � � '�r — Total Fee__ _ — -- <br /> ,�r:: <br /> Billing �Jame _ _-- <br /> Connect�on By <br /> Address "'�, '•� � •� _ Signed_.__ __-- <br /> c�„��,�„�, <br /> Phane_=- --_ '_ _ __ " - - <br /> DESCRIPTION: <br /> Lot_ / <br /> Block------- �"I 1� � <br /> Uivision or Addition__'_. • � �- - % <br /> Sewer Oistrict__ — <br /> _ __ ---� Monthly Sewer Service -- <br /> Remarks: <br /> -- —" � Monthly Sewer Constr._ — - <br /> -- APProved By • <br /> Ci1v Engnc«r <br /> __ _'___-- -_ ---- ISSUCCI By — <br /> icJDT -eati�v��`-��_ -- <br /> -----�s---b F _ -- �_Z- (_Z-7� ronnection Bv-- -- <br /> ._ ( ��� w,o • �561) _ - <br /> - —— Inspection By---- -- <br /> -- _ _ _ <br /> __ <br /> Datelnspecte�+___ .____. _. .. .._- . <br /> :ID - -- - <br /> ._----.__-- -- - �----� -�------- <br /> SEESKETCH ATTACHED <br /> � • <br />