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everett •� - ; — <br /> ; �)� <br /> ' � <br /> '� , TF� �_zo-�`.� ' <br /> I S <br /> City'of Everett ` � �i � � C ' <br /> Engineering Department ��V� <br /> Sewer Application and Permit <br /> � J�:� .�1 <br /> N0. �-� 17 H � DATE <br /> O . <br /> Service Address Utility Account No. <br /> Billing Address Connection Permit Fee <br /> City, State, Zi�_ Connection Fee /l/D�T ��i . _ <br /> Owner (Mortgagor) � Total Fee <br /> Billing Name <br /> Connection By " <br /> F\ddress ' ' Signed ������/ f%i9C/�/�-d� <br /> Cusmmer <br /> Phone <br />� DESCRIPTION: <br /> Lot <br /> Block <br /> Division or Addition � <br /> Sewer District <br /> Monthly Sewer Service <br /> Remarkr. _ <br /> Monthly Sewer Constr. <br /> � .J) ,LQa-ce..� 4'�...� , . <br /> Approved By <br /> City Engmcer <br /> Issued By <br /> �- ••-c��r.�. c�" �rn c�:..... -ma.Ea� a...� e.<w�¢ � <br />, . <br /> �������"�^ Connection By <br /> I <br /> �- <br /> Inspection By ���-H-'---� <br /> Date Inspected ���9 �� <br /> � <br /> SEESKETCH ATTACHED <br />, I'!SPECTION <br /> —r_: . <br />