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:-.� <br /> . _ . � � . � � l - . - <br /> everett � - I Z - <br /> �� � ' > % _ - . ,. . <br /> City of Everext <br /> Engineering Department <br /> Sewer Application and Permit <br /> � NO. �.OS� 7 DATE — i� JJij�3 <br /> I <br /> Service Address — � " � ' Utility Account No. � � <br /> i �,;, <br /> ; Billing Address Connection Permit Fee_ � <br /> City, State, Zip % i � Connection Fee �� - � � ' ' <br /> Owner (Mortgagor) � Total Fee � ' <br /> Billing Name � <br /> Connection By <br /> Address ' ' <br /> � Signed <br /> � � . � Customcr ,- � - -. <br /> Phone <br /> DESCRIPTION: <br /> �ot._ <br /> Block_ <br /> Division or Addition ' � � � . � �- s- : <br /> �/ <br /> Sewer District <br /> Remarks: i/� , � �_ �' Monthly Sewer Service � <br /> Monthiy Sewer Constr. <br /> i � <br /> � _ � <br /> � <br /> , , � <br /> ���'Lm A� (c �, r p-,c , ) APProved By � . <br /> L1.� �/ �'l J� City Eng�necr <br /> _ <br /> y���G{C Y� ���i Issued By r . <br /> .oi A.�,.l ��r��% <br /> Connection By <br /> Inspection By � L'a� �aIQ.J <br /> Date Inspected_�G�7�� <br /> � <br /> SEESKETCH ATTACHED <br /> . .`.f`.� ...-I-, <br /> -t___ _ '"e• <br />