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ev�rett <br />e <br />City of Everett <br />Enpineering Department <br />, <br />, <br />S <br />� ��° ~ ���� � %�/�� <br />� � . � ,,,., <br />,: <br />Sewer A,pplication and Permit <br />No.�'-0505 <br />DATE �• 1 � � � � � . <br />Service Address !. � � � ' '' ` <br />Billing Address � '�i�'�" � <br />; <br />� - , � � -.r ;' l ":. -r'-r � � � t � . <br />City, State, Zip <br />Owner (Mortgagor) �'_!_ i 11 .7�' ` �� <br />Billing Na <br />� <br />Connection By `� <br />':C-L.1/a..{-f '.�'r:�r�.'i'C ":. <br />Address �' � --r-�'f:-E:,`�� ,��: <br />� r:_ <br />Utility Account No. �_ <br />Connection Permit Fee -� J <br />Connection Fee <br />� <br />Total Fee ' � <br />� <br />� <br />Signed ' �� ; � ,� :_ � i �. <br />Customer <br />DESCRIPTION: <br />Lot <br />Block '' - ' <br />Division or Addition ' ' �= �' � ' �`� ` <br />Sewer <br />Monthly Sewer Service ' <br />Monthly Sewer Constr. � � � <br />SEE SKETCH ATTACHED INgPECTIOfd <br />Approved By %i,'_ , � <br />City Engineer � <br />� <br />Issued <br />Connection <br />inspection By—� �.�'-« � <br />Date Inspected ��� 3�� `� <br />