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evereK <br /> e � � <br /> ,, � � <br /> City oi Everett �,�` � �" � G l � _ 7 y <br /> Engineering Department <br /> Sewer Application and Permit � �,f �6 <br /> NO. �-� 256 DATE � ' ` � <br /> Service Address �- Utility Account No. <br /> Billing Address � - � � � Connection Permit Fee " <br /> Ciry, State, Zip � " ' '' !/ �'' �� � ' � Connection Fee - <br /> � 'i . <br /> Owner (Mortgagor) � � Total Fee � � ' �` � <br /> Billing Name '% -!'/-'�� - <br /> C:.'�-' - � <br /> Connection By � ',-� � <br /> Address . � �' -� � ' % .-- -- � Signed _ <br /> _ <br /> customcr <br /> Phone -� - %— ,_._`�'..-; ; . <br /> DESCRIPTION: <br /> - , <br /> Lot ' ' � <br /> Block � , �.I / <br /> , _ . -� .Y <br /> ,7 . , <br /> Division or Addition '%-� � � - <br /> Sewer DisVict ` - <br /> Monthly Sewer Service ' � � �" <br /> Remarks: ,i�.',� �,� �' : ,�� i ;; .� � , ;. . ��t �" ._. - , <br /> i ., <br /> Monthly Sewer Constr. <br /> � / , f • r <br /> ..•�G-+-. IO ! <br /> Approved By <br /> � � I�G C 1 p ' Ciry Engineer <br /> \ <br /> Issued By <br /> Connection By <br /> Insoection By � 'v`��---� <br /> Date I nspected�� 73 <br /> .� <br /> SEE SKETCH ATTACHED <br /> C i�;p.._���„�; <br />