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_ , <br /> everett - <br /> � � <br /> i <br /> City of Everett � � <br /> Engineering Department 1I_�� ��` / cI <br /> � ,. Z ¢- 7r <br /> Sew�r Application cna� P�rmit vw��J' <br /> rvo. �01U3 `� onrE - . . �_ 32�8q <br /> yo 3 . co�,B y <br /> Service Address�" "�t..' Utility Account No. "" <br /> Billing Add•ess_ - <br /> Connection Permit Fee ' <br /> CitY, State, Zip . ' <br /> Connection Fee <br /> Owner (Mortgagor�_ Totai F�e <br /> Billing Name <br /> Conne�tion By <br /> Address_ <br /> Signed <br /> Q�lOf1E Customer <br /> „ OESCRIPTION: <br /> Lut_�i <br /> Block_�_ <br /> Division or Addition <br /> Sewer District —' <br /> Remarks: Munthly Sewer Service <br /> __ Monthly Sewer Constr. — - <br /> �p�� ! <br /> �'.a`rtiv—y-Q�+�_ — a_ . . <br /> — Approved By i <br /> — —�--- Ciry E�gineer <br /> 'Q�L4���lJ\' .w -� -�� �i+'f�) �G��v� <br /> � ssued By <br /> Connection By ` <br /> _ Inspection By �// ��c.,...> II <br /> Date inspected_ 9/Z�73 <br /> :8I _ <br /> SEESKETCH ATTACHED � <br /> IfVSPECTION <br /> � I <br /> i <br />