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eVerett {�� � , 1 � . _ . . - <br /> / � ! � " ,�� �� <br /> � ' � ��� "' d '�'� ✓ <br /> ,�� , l; , � �� <br /> � ,� <br /> City of Everett <br /> Engineerinp Department � <br /> Sewer Application dnd Permit <br /> � .,�:; 32 <br /> i <br /> N0.'�LO 4 H :) DATE .�%r i•', ' ;� � � i � .:_�. <br /> Service Address � - i ` � ' '.'<�� �. Utility Account No. <br /> .� -, <br /> Billing Address Connection Permit Fee - <br /> , City, State, 2ip � .-�: �< (= -� � Connection Fee <br /> Owner (Mortgagor) , -- �l �°� �f'/ i ; � Total Fee �- , <br /> Billing Name <br /> Connection By � � '�' �. ! T"TL i_` � - ' ,J' <br /> _� _� _ ' ^ � �, <br /> Address ' i. �% U_ r1,-c • � ,..>i= Signed � <br /> Customer <br /> Phone ; ,'� . i) ; J L— <br /> DESCRIPTION: <br /> Lot i, C� <br /> � — <br /> i Block ' <br /> Division or Addition ' ^' �% ; r� <br /> Sewer District <br /> Monthly5ewerService_ - <br /> Remarks :', ��'� (/�_" <br /> , Monthly Sewer Constr. " <br /> � 59� /� � � <br /> � �.�` .�/ (.�J � �1 I'� a1-z,._A- APProvedBy_ � ��; � : .; r <br /> . Cily Engmrcr <br /> � <br /> 0��y Issued By <br /> -- Connection By <br /> Inspeciion By � 4" ".��-�-c�.�� <br /> � Date Inspec:ed ��,���Y <br /> i <br /> :Y/ <br /> SEE SKETCH ATIACHED � <br /> , � I`.)PEGlI��'1 <br />� <br />