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eve_.eit <br />e <br />City of Everett <br />Engineering Department <br />lr <br />�-, o- f � `� -=� <br />,� <br />� �� <br />,. <br />;_. <br />u <br />Sewer Application and Permit <br />; <br />NO. �04_I6 DATE i '-- '-� -- ,% �.�- <br />� Service Address " =, ��� - % � i `�f- '` �i ! Utility Account <br />Billing Address J^ <br />City, State, Zip � E-: J:' += T I <br />pwner (Mortgagor) ' � � �� <br />Billing Name ' '� <br />Connection By %�'�%1 f� H,L_ � t�-� ." fl -J = <br />j. `� �` �: �' �'�! <br />Address � � - � �-� <br />" `. ,.... � / - / �.r.. <br />Phone ` ' � " <br />Connection Permit <br />- -� <br />.. :---- <br />Connection Fee � <br />Total Fee � _ <br />✓ <br />; I <br />Signed �i_.-_, , � • i •' j �,_, , .��7 <br />Cusromer <br />i DESCRIPTION: <br />. Lot � . I -'t _ <br />/ . - -- <br />Block ,: i `' ; : <br />Division or Addition ' ' : ` �" f r - "�'% % � <br />Sewer <br />Y <br />"" thly Sewer <br />:� <br />SEESKETCH ATTACHED <br />irisPECTioi�! <br />thly Sewer Constr <br />�. � <br />roved By ' �,:� r:...'_ i.%,U �-' <br />Ciry Engineer <br />,d gy ��:.�• <br />nection <br />ection By � e�l(G�as.J <br />inspected `��Ls�7y <br />