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evereti <br />� IJ '--? ' <br />J <br />City of Everett <br />Engineering Uepartment <br />^, c. <br />�= (:' - �. <br />�;, % <br />�' ' <br />,-J`-J — <br />Sewer Ap�lication and Permit <br />rvo. :1-0 2 5 3 � DATE _ - , - � <br />,. . _ <br />_. <br />Service Address -- `- i--: _`, =-';, i,i��{` Utility Account No. <br />Billing Address `�'•"�� �- Connection Permit f-ee � <br />i <br />City, State, Zip '- -:--_'\ '; \',�r,l ' � ' Connection Fee — ^ <br />� <br />Owner IMortgagor) ' �.`� �, ' '�'� ' ��t� Total Fee ' <br />Billing Name <br />Connection By -'� `�'-r_� \ .,- �' �_�� r-_ <br />;,,— . - _ _ � <br />Address- —>�=>.:'_ ".-���1 CE-; Si ned <br />9 <br />Customer <br />Phone - — `�'" <br />DESCRIPTION: <br />Lot `, �� <br />Block <br />Division or Addition -'.� +;�J "� =-.__ <br />Seover District <br />Monthly Sewer ServicE <br />Monthly Sewer Constr <br />J <br />SEE SKETCH ATTACHED <br />li � ;PI-C1l0i�: <br />Approved By '' ,� . - —1_\_;;, , <br />� City Enginecr <br />Issued Bv " - <br />Connection By <br />Inspection By �-�+����� <br />Date Inspected��73 <br />� <br />