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. . .. '�: <br /> everett - I <br /> � . .� , ?� ) i Y <br /> .. i r' �.��i <br /> ( �' y Y <br /> City of Everett � <br /> Engineering �epartment I <br /> Sewer Application and Permit <br /> ,i �;�63 <br /> NO. .1 U Z �� <'� DATE - ' <br /> 1 <br /> Service Address r �� `� ' ' - '�� �� Utility Account No. ' <br /> "% � _ ! � � � �'/.f_' - - Connection Permit Fee - - � <br /> Billing Address r . t�' '� ti <br /> City,State, Zip r< ' � �' � '� � Connection Fee <br /> ' , �• • - r/t '"- Total Fee — � <br /> Owner (Mortgagor) , <br /> Billing Name <br /> Connection By �` <br /> i _ ' <br /> Address '" L�"' ' '" ��' J Signed <br /> , Customer . <br /> ' =-o . — ,/ . �. <br /> Phone ' <br /> DESCRIPTION: <br /> Lot <br /> Block <br /> � .. ,, .�i` )/ ' <br /> Division or Addition ' � <br /> Sewer District <br /> Monthly Sewer Service -- <br /> Remarks: ..'�'i.<�, %; <br /> Monthly Sewer Constr. -- <br /> y" J 'L i].�-.w-�-+� <br /> ��.1 .a �l � Y1 V- �i9 rL 5 W APProved By ,' � ' � <br /> �� � . City�En9�neer � <br /> r <br /> /,'" � <br /> _ Issued By ` <br /> Connection By <br /> Inspection By��"�� <br /> Datelnspected �`�L3�73 <br /> � — — <br /> SEE SKETCH ATTACHED INSPECTION <br />