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� <br /> )� <br /> everett - <br /> � ��� — / � — z � S. . , <br /> ,. �, , <br /> 2_ l' - '� 1� , <br /> City of Everett � Z <br /> Engineering Department <br /> Sewer Application and Permit � ;�b;�� <br /> NO. �l..O 1. � O � DATE ` -�.; 1�� ., /� �i _ <br /> -.�- - <br /> Service Address - ^�✓�` � : �A/ i %, Utility Account No._�-' - � .� ?`�` � � <br /> � <br /> Billing Address < , '' -,(.' % ,:��1 i�'"vJ/r. +7�� Connection Permit Fee <br /> City, State, Zip- � ✓/'�.�-'�-'"i�T �(�.� !�,.��'�*' Connection Fee_ .--i _ - " <br /> Owner (Mortgagor) � �,f d�. ' Total Fee <br /> Billing Name � . ''�-= <br /> Connection By _ <br /> ,� <br /> Address Signed - ' <br /> � - Cus�omcr <br /> Phone "" � <br /> DESCRIPTION: <br /> Lot ' -- <br /> Block � <br /> Division or Addition - : '. /� <br /> _ Sewer District <br /> Remarks: • Monthly Sewer Service �- "- <br /> �` ���_� <br /> Monthly Sewer Constr. -- <br /> „�r �,r 6 " ��� S�cQu <br /> oq �[ Approved By � i <br /> y ��/��o C S/" �� Ir�l � Q�V Engincer �. <br /> Issued By <br /> — Conneciion By <br /> �nspection By_ ���� ^+«-�-� <br /> Date Inspected_ 3� � 7�73 <br /> :� --- <br /> SEE SICETCH ATT! .;HED <br /> iSPL'CTION <br />