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w�.�i <br /> �) � —' <br /> r ' <br /> CCfI'Ckl -�- � � ) � '- (� � � � � ���� <br /> � �� / /1 ��� _� 1;���� <br /> i' '`, . -��' !' �,��- <br /> ( <br /> City of Everett <br /> Engineering Department <br /> S�w�r Applieation cnd Permit � � s � 5 <br /> , <br /> N0. = <br /> DATE _ ' �' <br /> � .__�-- <br /> Service Address - � � � ' L r�' � � Utility Account No. <br /> S �- '_ <br /> Billing Address ' <br /> �� / Connection Permit Fee �� � ' <br /> City, State, Zip%' � '% " �' � �,'� ' " � � Connection Fee ^ <br /> r� <br /> Owner (Mortgagor) ' � /� :'�'.,,7i-i� � Total Fee • ) � <br /> Billing Name ' <br /> � _.,i -. . .. - �� <br /> Y /� f r - t -, _ .. , <br /> Connection B �.. <br /> ,,.� <br /> Address ' ��� '� `' ` S 5. < <� Signed c,,,�om�� <br /> . . � �' • —_ .. .� .'/� _. <br /> Phone 7 — <br /> DESCRIPTION: <br /> Lot . <br /> Block�� ' - _ ,—' ,�c <br /> Division or Addition � __---- . <br /> Sewer District <br /> -- �— <br /> Monthly Sewer Service <br /> Remarks: • ' ,rJ�-�� �� -• Monthly Sewer Constr. <br /> i� �3 � G� � / !e � � c,. ct�� <br /> Approved By '� �' ,�. � � '': „ <br /> i f Ciry Engmeer <br /> ['�Y <br /> Issued [3Y <br /> Connection By <br /> Inspection By � v'�'� R^� <br /> Date Inspected y/��17 `� <br /> e <br /> SEE SKETCH ATTACHED <br />