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� <br /> i <br />� <br /> everetY I <br /> � � � � <br /> City of Everett <br /> Engineering Department <br /> I <br /> Sewer A;ppli�ation and Permit ' <br /> .:� � �:�4 <br /> N0. „ _ _ DATE _ <br /> ' _ L� <br /> Service Address_ _ Utility Accaunt No. <br /> Billing Address '%-" Connection Permit Fee_: <br /> _ ' i- <br /> � <br /> City,State, Zip � ��- � � � Conrection Fee - <br /> . <br /> Owner (Mortgagor) Total Fee - -- <br /> Billing Name <br /> Connection By � — <br /> %; / - Signed � �.� <br /> /�ddf055 Cusmmcr � <br /> Phone --- ---- <br /> D'cSCRIPTION: <br /> Lot_ <br /> 31ock <br /> Division or Additior. -- <br /> Sewer Gistrict ----- — <br /> - Monthly Se�ver Service <br /> � Remarks: � � � -� <br /> - Monihly Sewer Constr. <br /> �� !ob'%y � �'� _ ,v�' `� S� S l4a <br /> r 0 <br /> Approeed Dy ; �/+ _ <br /> ��� �t ''� City En9ineer <br /> I ' �a-c..pa_ <br /> Iss�.:ed [lv------- � - -- <br /> �yb_� <br /> — Connectinn BY- - ----- - - - _ _ . _ <br /> —.— � - r <br /> — Inspection By—. ' � �•L�'�2`°`^� - <br /> 2 � <br /> Date Inspectecl_='��1'_��__ - — <br /> - — � <br /> SEESKETCH ATTACHED <br /> —,,�.��� - - - --- — - <br />