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everett <br />� <br />City of Everett <br />Engineering Department <br />� <br />l�_30_2�_` <br />r�f-lc�� il-������ <br />J ;>>�� <br />Sewer Application and Permit <br />N0. ��v2�2 � DATE <br />Service Address�]�8 '� `` �� "`- �'" �' Utility Account No. <br />Billing Address '`�' r�"' '�` '�/ %' � Connection Permit Fee_ <br />City,State,Zip = i�'�"��!% C�/�/ '.r` ._" ; ConnectionFee � <br />:� <br />Owner (Mortgagor) "✓ �'F- � '/f � %'�' Total Fee � � <br />Billing Name "`����� <br />� ., <br />Connection By � ' �� � �� �" � ���'�� <br />Pho <br />Signed <br />Customer � <br />DESCRIPTION: <br />Lot ' '' <br />i� i <br />BIOCIC � ` , <br />Division or Addition � -' % � �% -'<<t � �/' <br />Sewer D <br />SEE SKETCH ATTACHED <br />�I:SpEC�fln1�! <br />--- --. <br />Monthly Sewer Service ` --- <br />Monthly Sewer Constr. � <br />/�pproved <br />ISSUECJ <br />, � 1 <br />� � ; j' � . . <br />City Enginem <br />Connection By_ <br />Inspection By <br />Datelnspected <br />