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Pu�:reT: <br />,� <br />City of Everett <br />Engineering Uepartment <br />I �7� � �7 <br />! <br />s <br />.,, �,r'�;-'� <br />��' . L . <br />Sewer Application and Permi� <br />; <br />N0. �O 15 O DHTE <br />Service Address_ ' ' , <br />Billing Address <br />City, State, Zip " <br />Owner (Mortgagor) <br />8illing Name <br />Connection By �''i�- � <br />Address - <br />_ � '. . , �: <br />Phone , <br />DESCRIPTION: <br />Lot - <br />Block_ <br />Division or Addition " <br />Remarks: - <br />����P�'c,s,�i.�.,� a..��..,��tinu,. n ��� } z �� � <br />� � <br />.,.o� _ � •� ,�� E.S �� .�...�-� ti,[.r .2,�.-�, •C��3 R <br />�.s..� . � /il <br />-- _ <br />�Ac.y,'f � 023'�3?/7 <br />2 3�33/ 8 <br />Utility Account No. � <br />Connection Permit Fee � -'�=-�- � <br />Connection Fee - - <br />Total Fee <br />Signed <br />SEE SI<ETCH ATTACHED _ ; ., <br />� <br />Sewer District= • ' <br />Monthly Sewer Seroice - '-� <br />Monthly Sewer Constr. <br />Approved By � - <br />Ciry Engincer <br />Issued BV <br />Connection By — <br />Inspection By ������u"'� <br />Date I nspected S�C `1��J' <br />� <br />�.. <br />