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everetl i, <br /> � / <br /> City of Everett <br /> Engineering Depertment <br /> Sewer Application and Permit ' <br /> � �;�t95 <br /> N0. �. ' I �_ ! � � / DATE � <br /> LC.i'. <br /> Service Address <br /> � Utility Account No._ <br /> Billing Address Connection Permit Fe•. � <br /> D Sa <br /> City, 9tate, Zip � � Connection Fee!/�/� ����'" ���— <br /> Owner (Mortgagor) z� '_ Total Fee <br /> Billing Name <br /> Connection By ' <br /> Address ' ' - Siyned <br /> Customer <br /> Phone � � <br /> DESCRIPTION: �� <br /> Lot — -� /y// <br /> Block_--.— i� / <br /> Division or Addition — �� �3� <br /> Sewer District__5__. — <br /> Monthly Sewer Service � <br /> Remarks: �O, `� <br /> --- Monthly Sewcr Consv. <br /> — -----1- <br /> <� .i �� , _ ,g0, � - ,l; /�/-I�vl�! L�A <br /> � _" �"c.c� rf.t•{/`.` ��� /Ynt <br /> ` / / <br /> `�15 �j_�S�-� Ca.�nsta-y-�- Approved BY— - <br /> - - <br /> -- — <br /> � Ci1y Eng�neer <br /> __. -._. . _. -- -�"— <br /> p __ ____— <br /> fy '�'�� S/ _���1.._��-�-Ea^^ -G- Issued BY -- <br /> �.dL �2�- ����� - <br /> � — ' p" <br /> � �t�c� - --- ----- Connection By-- -- — <br /> - - <br /> � , <br /> ---- _ — __ — - Inspection By—�) ! _ ?�tu"'� -- <br /> _ - o,�� i�,5�«��d�!y�7-=�-- --- — <br />� — ---- — ---- <br /> -----------_ <br /> .� <br /> SEE SKETCH ATTACHED <br />