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everett <br /> � , � ,� u , � <br /> r <br /> City of Everett I ! �� <br /> Engineering Depertment <br /> Sewer Applicction and Permit <br /> � .: (iS15 <br /> N0. �� G U �i � DATE <br /> ,... <br /> Service Address��.' :�' . . ,< Utility Accaunt No. � - - <br /> Billing Address - Connection Permit Fee �� c- � <br /> City, State, 2ip_ ',�:/ ' _ , /',. Connection Fee - - - <br /> Owner (Mortgagor� �'� � Total Fee � � <br /> Billing Name_ ` ' ����:- � <br /> Connecticn By ' `1 �� � � R <br /> Address Signed_ ���.� (�_` {. � <br /> C:rs�omer <br /> PhOI1C <br /> DESCRIPTION: <br /> Lot <br /> Block_ -�_ <br /> Division ar Addition � _� �1'�_ __ <br /> --- Sewer District <br /> PAonthly Sewer Service <br /> Remarks: i % ).:.j ,1/�/(, � /%NI/ ?" — <br /> Monthly Sewer Constr. <br /> �.s�.c_�-S��«��� v� ���5 � �c.� �-v APPro�edBy_' , <br /> �._ . <br /> _ ! <br /> City Engineer <br /> � <br /> h c�'ct_o , <br /> � Issued By � ___ <br /> -- Connection By __ _ <br /> Inspection By .�'% �`�G-C.��2 ✓ <br /> / <br /> ___ Date Inspected_./_/_�7 3_ <br /> -- -- <br /> � ----- ---- --- _ -- - <br /> SEESKETCH ATTACHED ' <br /> < _ �� ,�,r� - i <br /> ... ,\ , \ ` • . <br /> � -` . ��. <br />