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everetl — I . . <br /> � , � , <br /> , <br /> , � � , <br /> ��I �. � � I�.J — <br /> � '� / • <br /> City of Everett �" <br /> Enpineering �epartment <br /> Sewer Application and Permit <br /> rvo. � 0071 ✓ DATE � 3�4�j2 <br /> ----------. <br /> Service Address�/ S �• ! j <br /> ��� �^— Utility Account No. <br /> Billing Address_ i � ,. �/� } <br /> — Connection Permit Fee 1 <br /> Ciry. State, Zip • f , " ,' (. . `i � __I_...___ <br /> Connection Fee <br /> ------------__ <br /> Owncr (Mortgagor) �'�/ " ,^ � , i. , <br /> Total Fee � <br /> Billing Name <br /> Connection By � i � , <br /> Address •�' �� <br /> � <br /> - Signed <br /> Phone ` : c�s�om�r <br /> DESCRIPTION: � <br /> Lot�__ - ✓ <br /> Block_ ; <br /> Division or Addition � !: <br /> Sewer District <br /> Remarks: � 1 � ; Monthly Sewer Service <br /> _� ,. <br /> y � C __ Monthly Sewer Constr. <br /> ).�=s. . 3 L � 5`--_7 !� � ,_.e.'"�' ��c�,-, <br /> �--`�-sL%� � <br /> APProved By_ ! <br /> —�---- Gty Engineer <br /> —� Issued By_______._ <br /> ----_ <br /> -- Connection By_ <br /> --- Inspection By�%� � �,� <br /> Date Inspected� 7 3 <br /> � <br /> .ID <br /> SEESKETCH ATTACHED <br /> �.....�n.�•)�l l�� <br />