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`\ , <br /> everett � <br /> _ / ' ) c` i,l ' _ <br /> � ��� � � � � <br /> ta_: ,;� <br /> , � <br /> City of E��erett <br /> Engineering Department • <br /> Sewer Applieation and Perm�it <br /> •J � I. .� � <br /> N0. .1 'J '} _. U DATE " — <br /> Service Addres, - Utility Account No. <br /> Billing Address � -��� Connection Permit Fee �� <br /> City, State, Zip - Connection Fee � <br /> Owner (Mortgagor) ' _ Total Fee_. � - <br /> Billing Name ' — <br /> Connection By - — <br /> Addrass ` Siyned y ' <br /> Cusmmer <br /> Phone <br /> DESCRIPTION: <br /> Lot <br /> Block <br /> Division or Addition_ _ <br /> Sewer District <br /> Monthly Sewer Service <br /> Remarkr " - - -- - <br /> Nlonthly Sewer Constr. <br /> � <br /> a?/�' S /Y1��.2 � �r/ <br /> — Approved Ciy <br /> City Engnrecr <br /> �� 3 /� Issued By <br /> r <br /> Connection By <br /> Inspection By � �-���2i�" � <br /> Datelnspected �"��1G�73 <br /> _ r� <br /> J <br /> SEESKETCH ATTACHED <br />