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i <br /> � .� <br /> everett , ' '� � - � � _ � , - . .. <br /> , 1 ,`� �_ I _ ! ` <br /> � � t . ,�r, <br /> , <br /> � <br /> City of Everett <br /> Engineering �epartment <br /> Sewer Applic�tion anc� Permit 32305 <br /> NO. ..LO2 �� E� / DATE <br /> Service Address ' " Utility Account No. _ <br /> Billing Address l` ' _ Connection Permit Fee ^1 � ,` <br /> Connection Fee <br /> City, State, Zip '" . <br /> Owner (Mortgagor) '- Total Fee <br /> Billing Name <br /> Connection By <br /> - Signed <br /> Q(Jdff:55 Custoin_r <br /> Phone._ _._ --.— <br /> DESCRIPTION: <br /> Lot .�' <br /> Block_ <br /> Division or Addition_ ` - _ : ;'J -- --- _ <br /> Sewer District <br /> __� <br /> Monthly Sewer Service �� <br /> Remarks: %�� " <br /> Monthly Sewer Constr. <br /> �C2 u.(�,� ' �' <br /> Approved By_ ' <br /> I .I �/ Ciry Engincer <br /> C1 2 <br /> Issued BY - <br /> Connection By <br /> Inspection By_.,qn�����1 '`'d'l-"� <br /> Date Inspected ��' �� 3 <br /> � <br /> SEE SKETCH ATTACHEC INSP[C�IOP� <br />