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everen <br /> � �"�� � -���� ��-cnl' $: F� �r�� <br /> J�' � ),��� <br /> City of Everett <br /> Engineering Oepartment <br /> Sewer Application and Permit <br /> 33i51 <br /> NO.�,�� D ����-I � DATE _ ; , ,� <br /> .- <br /> Service Address � " Utility Account No. `— <br /> � � <br /> Billing Address = Connec[ion Permit Fee ' <br /> City,State, Zip - r. ;-= i;:" _ Connection Fee <br /> Owner (Mortgagor) - ='� ' - F ' . -= C- Total Fee <br /> Billing Name � � ' ' � <br /> Connection By ;' � % -�� +� �) ��.) <br /> Address �? � ��,UJ'7 i / .�.� ��—� f� �j . Signed� , . <br /> _. ._ 1 cu:tomcr <br /> Phone_ � __ ! <br /> DESCRIPTION: <br /> Lot • ' <br /> Block�_ <br /> Division or Addition -/, `_ -' - <br /> Sewer District <br /> 1 Remarks: � � 1 - � Monthly5ewerService � �" <br /> a:f <br /> Monthly Sewer Constr. <br /> �O `/�f1 <br /> � .�.u..`�� �� z" � � SPx � -�,�. � <br /> U � '� APProved By -'.c� ,�-� ,� �.: ; <br /> i �,Ju,.�� ' � �n Ciry Enginecl <br /> Issued By " <br /> Connection By <br /> Inspec[ion By—l� • ��, <br /> Date Inspected / � `/ 7Y <br /> .m <br /> SEE SKETCH ATTACHED <br /> , INSPECTION <br />