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evere� i <br /> � � � . - � _ . - c.. . , .. � � <br /> � i � <br /> City of Everett <br /> Engineering Department <br /> Sev�er A�apl�cation and P���m�t � <br /> , <br /> �. ,y ;�� <br /> N0. .i.. ij ',_ '.: i; J DATE _ <br /> � - <br /> Service Address � Utility Account No. <br /> Billiny Address :-_�_." " ' ' � Connection Permit Fee ~' � <br /> _ !�e�;�;� , . . � '-� <br /> f.f"�� ' ' ' °; ' � Connection Fee_. � ' '� — <br /> City, State, Zip � �� <br /> Owner (Mortgagor) ' Total i!ee � <br /> B;Iling Name %- '%''� <br /> ,._� _ <br /> Connection By <br /> Address_. �'� �i, :1 S�gned_ --- <br /> cusmmer <br /> _ _ <br /> Phone ' � � � % � — <br /> DESCRIPTION: <br /> Lot -- ' ' <br /> Block_ — , �� <br /> Division or Addition � %•' ' "� <br /> Sewer Dis[rict <br /> _ Monthly Sewer Serv�ce <br /> Remarks: ;:/ .;�,;i,; -. -��' ,' �„j <br /> — � Monthly Sewer Constr._ <br /> 49 �' �vin �L� b �, i1.- � s W <br /> r , <br /> �,(?J��J1, �hn /�-'G ApprovedBy CiryEn9mcur <br /> y �il �° CS� .a-�-�� �.. 'is Q�c-o—"- " IssuedBy <br /> Connection By <br /> e �� „ Inspection By � �l�`����`'�"� <br /> ` �._ , <br /> Date I nspected �' ' '� � �-- <br /> � <br /> SEESKEI'�H ATTACHED <br />