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� <br /> - . .. _ I <br /> everett 1 � 7 ;-, ._ . - .. ... <br /> I �� r� ,� �� <br /> � I � U � �, <br /> _J � <br /> � - 1��'7 ' , <br /> City of Everett ;j,= `1' ' <br /> Engineering Oepartment <br /> Sewer Ap�lication and Permit <br /> ��,eo� <br /> N0. �>O 1 h I � DATE <br /> � 3„1 3 f=���7'��.v <br /> Service Address - Utility Account No. <br /> � � <br /> Billing Address _ Connection Permit Fee -- <br /> City, State, Zip Connection Fee - <br /> Owner (Mortgagor) Total Fee � " <br /> Billing Name � � a- <br /> Connection By '�F � � � <br /> �l � . , � <br /> Address +' g - '� t:� <br /> < Si ned��1"V� �-!-''"�—" ��'� <br /> � �'1 " Customcr <br /> Phone -- /.�' S ;� v` <br /> DESCRIPTION: <br /> Lot - � <br /> Black_ <br /> � 1 <br /> Division or Addition - �� � <br /> Sewer District <br /> Monthly Sewer Service � �" <br /> Remarks: - � /. <br /> Monthly Sewer Constr. -�-- <br /> <:e,w�,_s�(� ct.� �/�� Y/ � �-! � S'�� APProved By � � <br /> ,�, <br /> Cily Engincer <br /> 3i - <br /> � Iss��d By - <br /> Connectian By <br /> Inspection By `LL�-r <'tct�,---� <br /> > <br /> Date Inspectedi,ra�t''},c�"�;t,.�x'•'•s"�`-��•' ` <br /> �.y�y��� / <br /> � <br /> SEE SKETCH ATTACHED <br /> !fJ5PI-('� �,�p� <br /> —c:. _ <br />