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everett <br /> � � ; � j �.,��.�j <br /> City of Everett <br /> Engineering Department <br /> Sewer �pplication and Permit <br /> n � �b <br /> NO. �:�f li l :, u DATE � � - � -- ' � �� <br /> Service Address � i` �. 'P-��'�:� ' i � Utility Account No. <br /> Billing Address `"' '- - <br /> Connection Permit Fee_ <br /> City, State, Zip � T "� - I �" - � ; Connection Fee <br /> � ! _ - <br /> Owner (Mortgagor) -i '�� �'„� + - •-r, r.... _ Total Fee - - --- <br /> Billing Name �' 1 c=- <br /> i . � <br /> Connection By_ t-i �,•'��- tZ -i '� rt }r- <br /> Address > � L-'-� ir\Jt .-'12� "(� , � '� Signed <br /> Cusromcr — <br /> Phone " =%'�� -- .�-1 "Z 'Z_. <br /> DESCRIPTION: <br /> Lot <br /> Block `� `.-� <br /> � ; <br /> Division or Addition�;���'E 1 T ;__.A�'J�\ ! 1 1'� � �'- �' <br /> Sewer District <br /> Monthly Sewer Service --" <br /> Remarks: �.:y»_)� ��� _ — <br /> Monthly Sewer Constr. " " <br /> �,� � «,� �'/�� �12 ' 3 5i� �/" <br /> Cw,� a � dLa...,o � <br /> Approved By �---� `��_;�, ' <br /> �Ciry Engincer <br /> Issued By <br /> Connection By__ <br /> Inspection By ti� ��"`��`"'� <br /> Date I nspected�3�/> 3 __ <br /> 7 <br /> SEESKETCH ATTACH[D <br />