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;:� . <br /> everett � ' � <br /> r, ! � L� � <br /> � ��� <br /> City of Everett <br /> Engineering Department <br /> Sewer Application and Permit <br /> J .� al �.l) <br /> No.�.05 :i1 DATE <br /> Service Address ' ' � ' � � � }/�lJtility Account No. <br /> Billing Address Connection Permit Fee � <br /> , � , �-' �, ,i,-. . . . � -- <br /> City, State, Zip � - /' ' � ' � � Connection Fee <br /> Owner (Mortgagor) ' ' � ` Total Fee � — <br /> Billing Name <br /> , , <br /> Connection By ' '"' <br /> .,- - ��r_ y � ,i _; Signed ' . ,,_. <br /> A(�d'CSS � Customrr <br /> . ,t'i ..� Y._ �l <br /> Phone �r3 -- •:,r/.( '7. <br /> . � <br /> DESCRIPTION: <br /> Lot ' <br /> Block <br /> Division or Addition ' �` - � ' '� T <br /> ,- , / <br /> Sewer District ,y "" � <br /> Monthly Sewer Service -- �' � <br /> Remarks: ,�1 ,�. .� , . . ;y� .- - , ' <br /> Monthly Sewer Constr. '- - � <br /> , _ � � . <br /> _ , : <br /> l.1/'�L'o-",,�•y' 6 ' �—�i s��I/`� - Approved BY �' �- <br /> Ciry Enginccr <br /> � (�' �-S P � ''�`c �c^-�� I ssued By <br /> Connection By <br /> � �� - ^L - --�\., ,/ <br /> — . � '! Inspection By �• �-�l14 la'� <br /> +� . -, � Date Inspected 3 7 � <br /> � <br /> :� <br /> SEESKETCH ATTACHED <br /> INSPECTION <br /> _�e,.._, ....._....� <br />