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everi�ii / A t .� �/ � � 7�� M1 . . <br /> � � I � .��� � r /! <br /> / 1 /. <br /> ! <br /> City of Everett <br /> Engineering Department <br /> Se�ver Appli�ation and Permit <br /> � � � ss <br /> N0. 1 QL�. Cjp DATE _ -- _ — <br /> , <br /> , <br /> Service Address : Utility Account No. <br /> Billing Address Connection Permit Fee " <br /> City, State, Zip - � Connection Fee -'- <br /> Owner (Mortgagor) �-��''T': �=� ' + :� "" Total Fee � <br /> Billing Name <br /> Connection By �`. � �"�• � , <br /> Address > � :i _ : % ; -"- , ; � Signed <br /> ;-� ,�.: Customcr � <br /> '��.�._ �.��� � "�' . <br /> Phone �' r� <br /> DESCRIPTION: <br /> Lot � "�� <br /> �+ ° - <br /> Block <br /> Division or Addition. = ' "� " - Y ,_ <br /> Sewer District — = � <br /> -- Monthly Sewer Service <br /> Remarks 'Tjj,�/p,�LgGip1, f ,�— <br /> � , Monthly Sewer Coristr. <br /> ti <br /> , r } <br /> APProved By ;:'!� <br /> J City En9incer <br /> d� <br /> (�� �^°'c"v� � L�' v" �� � i ' Issued By . .'� . <br /> �r� / MOO��!' � r `�'c�G�C'S�"-,--�' "P�."""" Connection By <br /> ' Inspection By_ lW ��"C�^"*�-� <br /> ' Date Inspected ___������`/ <br /> � <br /> SEESKETCH ATTACHED <br /> INSPECI'ION <br /> • _ �F� ���� • <br /> . : ! ' y2� 5 'a'4 .� : <br /> . . ., `�:4�i ���. <br /> . . . . . ._ .. . . _ .. _a`::x.a:...�..»�ak-.,1..v . +.rw_.'`.,.r_^-� �i . <br />