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% <br /> � <br /> everett % <br /> � � - 5 % <br /> � /I� f � � .. : � � <br /> , �. <br /> ;�, <br /> � �`^ , �� <br /> � <br /> City of Everett <br /> Engineering Department <br /> Sewer Application an�d Permit <br /> �j �640 <br /> N0. �O 1 S 2 / DATE �/" �' <br /> . '> - •- �! � - <br /> Service Address ' 's '' iV//'"n ���,,li Utility Account No. � � �= � % � � , � � — <br /> -t� � Connection Permit Fee <br /> Billing Address •sT ' '" '� ` ' `"'�' � <br /> City, State, Zip <br /> '!; %"i if� ,�-` -� Connection Fee � <br /> ',c� ' f %',/i Total Fee � <br /> Owner (Mortgagor) �_ � ' <br /> Billing Name /"� ,' ' — � <br /> Connection By 'r s'� "` - <br /> Address Signed ' • '� ' <br /> Cusromcr <br /> Phone : � <br /> DESCRIPTION: <br /> Lot <br /> Block _ �k � <br /> Division or Addition �'r <br /> r-- <br /> Sewer District <br /> Monthly Sewer Service - — <br /> Remarks: %-r' ,7;� , -- ' : <br /> Monthly Sewer Constr. ' " - <br /> 'G`v,,V, � 10'� .t .�� � <br /> . <br /> Approved By : � , � <br /> G � � � � � � Ciry En9ineer <br /> ISSUCCJ By _ <br /> Connection By <br /> � <br /> Inspection B�� p��°G-' <br /> Date lnspecte� 3L-� � 3 <br /> � <br /> SEE SKETCH ATTACHED �NSPECT�. " <br />