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everett � � —7_O '�r - 5 � <br /> -- �' � - <br /> � ��( <br /> City of Everett <br /> Engineenng Department <br /> Sewer Application and Permit <br /> 3�496 <br /> N0. l.rIOO � J % DATE <br /> Service Address � �d � O /rG�G Tc�w/ Utility Account No. <br /> \ <br /> Billin Address 30 , °� Ntwc�u. <br /> 9 Connection Permit Fee �-` 20 .�="� G'.8's� <br /> � <br /> City, State, Zip__ ' Connection Fee • <br /> Owner (Mortgagor) _ Total Fee �� " <br /> Billing Name <br /> Connection By • <br /> Address Signed <br /> cu:romer <br /> Phone- - <br /> DESCRIPTION: <br /> Lot _ <br /> Block <br /> Division or Addition <br /> Sewer District <br /> Monthly Sewer Service <br /> Remarkr. , 't ,, -� . <br /> Monthly Sewer Constr. <br /> i. .1 / <br /> � ,Cau.� Is Yl9t�..,� �.u� 2.� � 1�`� Appro��ed By <br /> g���tp.,.� ' � 'yr��� ^ CiryEnginecr <br /> G rr�i� �?Q'� �u��� �� �/ [ Issued By -. <br /> C .�.4� � S '_ <br /> Connection By <br /> Inspection By �• � u ( (4 � � J <br /> Date I nspected��/��� ��— <br /> � <br /> SEESKETCH ATTACHED <br /> IN5PECllON <br /> —�__ _., <br />