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1 i <br /> . ' <br /> �Vr'eh <br /> � �c�l' . / <br /> City of Everett 2 � 2v � � � <br /> � <br /> Engineering Departmeat <br /> Sewer Application and Permit <br /> 3z � 31 <br /> NO. /�O �Z H O � DATE % �� •' -� <br /> i <br /> Service Address - � `�i%'r' -��!' _ Utility Account No. " ' ' '7 � <br /> Billing Address � ' �/�'�>�`� =� "'� Connection Permit Fee '' � ' <br /> City, State, Zip � ��`= rT 1 1/a ' ! � � " Connection Fee ' '" _ <br /> ! . ;1� <br /> Owner (Mortgagor) � ' " .��^ %�- "� � � '�--Total Fee " <br /> Billing Name • �1 ' s � <br /> Connection By "" � ���.' �%f `- <br /> Address r:7 k- r= t r •r-.�� — Signed •' - <br /> Cuslomer <br /> Phone " J � <br /> DESCRIPTION: <br /> Lat - �i- <br /> Block �i <br /> Division or Addition_,= ' ' f-" • � •' � `i� '� � <br /> �. <br /> Sewer District <br /> -, � <br /> — Monthly Sewer Service - '—� <br /> Remarks: � ;_ c.<) ' �� : ; � ._-<' — ;,,,j �- u c� <br /> Monthly Sewer Constr. <br /> y-���,.,� z 6 �- �,r� ,� � ' <br /> , , <br /> Approved By_ ; .� ;r'�c l./i� �:� <br /> (/ �� �a�'P � �4 � • � � ` Ciry EngineQr' . <br /> F— � <br /> Irued 8y � ' <br /> - Connection By <br /> Inspection By � �-��� <br /> Date Inspected_T/�'2'�7 �j <br /> � <br /> SEESKETCH ATTACHED <br /> I���,-PEi:I I�.)PJ <br />