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� <br /> , <br /> everett _— <br /> � - ^ <br /> /�� -� � �' �`' '' <br /> _ .� c, - %`�" <br /> City of Everett �> <br /> Engineering Department <br /> Sewer Application and Permit <br /> 3�(�3� <br /> N0. LO 1 I � � DATE _ - ` ,^ <br /> ,�iJ'�. _. ✓� i _'` — i 1 ' 1 <br /> Service Address_ ` % ' '�V Utiiity Account No. -- - <br /> Billing Address � 1--�*''�� �-'��"-' ' " Connection Permit Fee <br /> , <br /> City, State, Zip � ! ����. '�! `-/ Connection ree -' � <br /> Owner (Mortgagor� i ,� • , Total Fee � :3�====m �: � � -? CJ <br /> Billing Name �•' �� <br /> Connection By <br /> � <� <br /> Address_ Signed ' ' � <br /> Customer <br /> Phone — -7 <br /> DESCRIPTION: / <br /> Lot I f <br /> Block � <br /> Division or Addition ' _ <br /> Sewer District � <br /> Monthly Sewer Service "� <br /> Remarks: <br /> Monthly Sewer Constr. " <br /> �n- � G � ct� � Y � r O-� <br /> � W�7� <br /> /� // .�P- Approved By ., <br /> � ,���b C S� /J-c�KI -4��w1-c.l. /<X �-ie� � ' CitV Enginccr <br /> Issued By � <br /> Connection By <br /> Inspection By �"��x4^"� <br /> Date I nspected�l�/ 7.3 <br /> � <br /> SEE SKETCH A'iTACHED <br /> Ih1SPECTION <br />