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.----T. ^ ~ - - • .. <br /> everett l � �� <br /> e `j- 1 .. ` - � � ��,',� <br /> / - zl 7 <br /> City ot Everett <br /> Engineerinp Department <br /> Sewer Application und Permit <br /> . . . ,.1 „ <br /> J .iv I b <br /> N0. . ,_ .. ,_ DATE :- , : i <br /> Service Address_-� % ;- ,- � � Utility Account No. ' <br /> Billing Address. ±' i . � Connection Permit Fee_ % <br /> City, State, ZiP ��—� � , `� � UI N Z U � � � �-�� _ % . � � i <br /> ' � Connection Fee <br /> Owner (Mortgagor) %� ' � . ; -- l � .`. , � Total Fee <br /> Billing Name_ <br /> Connection By - " �'�' �:- <br /> � . ' <br /> i:_ ! <br /> Address— ' _ Signed 1; i ? r� �T � 1 , ,. <br /> PhOf10 '�� � �.}_' . Cusromer -- <br /> DESCRIPTION: <br /> Lot ' <br /> Block ` <br /> Division or Addition ` <br /> Sewer District .�- <br /> Remarks: ;�; ;, ; , _ ., � ,,. y' MonthlySewerService - ` <br /> Monthly Sewer Constr. - <br /> y ��C.�-..,.. G "�I' c�o� 6 ' <br /> �'�/��O' C S �' lLsk � APProved By ' ; ,i , <br /> � � Ciry Engincer <br /> ISSUBCJ �iY . � <br /> Connection By. <br /> Inspection By �• ��G��'��„--- <br /> Date Inspected��7�/ <br /> R <br /> SEESKETCH ATTACHED <br /> —.�•-. <br />