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everett <br /> � ' _�>,, i <br /> -�_ .. • ,��i, <br /> City of Everett ;_ � <br /> Enginoering Department <br /> Sewer Appliccatior� and Permit <br /> ,; <br /> � � � 4 � <br /> N0. �-�..�J 1_ :i ( DATE — _ � -,_ <br /> Service Address � %' ' 't ' -�\�=_� , ' --- <br /> Utility Account No. <br /> Billing Address Connection Permit Fee <br /> � <br /> City, State, Zip ` �~ � ( . �� i �' � .% ' f � Connection Fee ' — <br /> , � � _. <br /> , . , � ; . <br /> Owner (Mortgagorl ' � ' : r ; ? :'. ", ' , `'. ' _-- Total Fee — -- <br /> < < <br /> Billing Name <br /> Connection By t' i'� •' <br /> Address___ �- S �`_tT��7 "f `1 � <br /> Signed <br /> cusiomcr <br /> Phone ' <br /> DESCRIPTION: <br /> Lot � <br /> Block � � � �` � � <br /> Division or Addition'_ � <br /> Sew2r District <br /> Remarks: „#=.�.� >t�� ,- ;��:� <br /> Monthly Sewer Service_ <br /> Mor.thly Sewer Constr. <br /> ,.:1�-._,.f-4 C C�'o� /6 2 � )1 �Y 2 <br /> e s � � <br /> Approved By <br /> �. City Engmccr <br /> � <br /> Cc�,�„��.��/ �Q, 3 3l R--9— Issued By '.—F _ ;_ <br /> - "� ao �3 �' <br /> � Connection By <br /> Inspection By���--- <br /> Date Inspected ��3 °��3 <br /> J------ �- -- <br /> SEESKETCH ATTACHED <br />