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�. <br /> everett . �,1�� - / �- `" � � � , � <br /> �;�,1, <br /> � /�_ -26 — 7 �� ✓ "• ' <br /> City of Everett <br /> Engineeriny Department <br /> Sewer Application and Permit <br /> �z52s <br /> NO. .�- � -� ? 7 DATE " , =' <br /> i _ <br /> Service Address � Utility Account No. <br /> Billing Address ' i Connection Permit Fee <br /> City,State, Zip - _ /7 ,. �'��. , �% ' Connection Fee � <br /> Owner (Mortgagor) Total Fee <br /> Billing Name � <br /> Connection By <br /> � �/ Si ned <br /> Address � 9 - <br /> � � � � � � . � ' " � Customcr <br /> Phone ' <br /> DESCRIPTION: <br /> l.ot_ <br /> Block - <br /> Division or Addition <br /> Sewer District <br /> Monthly Sewer Service '� <br /> Remarks: _ ,�_: <br /> Monthly Sewer Constc > � - <br /> .,� "'Co-�-�-.-� �. G �c r.T.E.T �°�� � ��c�� <br /> � <br /> (r � AppfOVCCJ BY City Enginccr/ J <br /> �F �(: � S �' �.�-.e = <br /> Issued By , <br /> Connection By <br /> Inspection By <br /> Date I nspected_�_� � - �j <br /> .'ID <br /> SEESKETCH ATTACHED <br /> IP:SP�C�i Il;i� <br />