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i��� I <br /> evere�t �� - ; �. - - ;.� <br /> �' ��- �: �,,,,,( ��; _ ._ , <br /> ♦ <br /> City of !'verett 3 2 2 71� <br /> Engineering Department <br /> Se�ve►� Application anc� Permit <br /> NO. ;ZOOO7 � DATE <br /> •��%y Wesy" Gle�vhauP� <br /> Service Address__ Utility Account No. 3� � � ?�–' � o O <br /> Billing Address Connection Permit Fee <br /> City, State, Zip Connection Fee <br /> Owner (PAortragor�__ Total Fee <br /> Billing Name _ <br /> Connection By _ <br /> Address _ Signed <br /> CustOmcr <br /> Phone <br /> DESCRIPTION: <br /> Lot <br /> Block ,L <br /> Division or Addition <br /> Sewer District � <br /> - — Monthly Sewer Service <br /> Remarks: ti�Zc�,1 �,,,�y� Tio.v -- <br /> �� r�(�n_� � ( •- �� �x- �o�� / �j ��-- Monthly Sewer Canstr._ <br /> �-`� '" '�r;a � S--�i )���n.��C�rM <br /> � <br /> y „�7 �+ . Approved By <br /> /�� L,J � .-� .ea�.v�LV � CitY Enginccr <br /> F����`"�' ` -� Issued By __ <br /> -- Connection By_ <br /> Inspection By �=� ' �� <br /> Date inspected %– �Z – 7 Z <br /> :YJ <br /> SEESKETCH ATTACHED <br /> INSP�CTION <br /> � <br /> ��i <br />