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� `- <br /> � evec�tt � �" — ._ �_ - __ ' <br /> �� ' <br /> i ,� � � �� ' ��- 7�- � <br /> � :, � <br /> .- <br /> I `� - <br /> � City of Everett <br /> i En�ineeriny Uep�rtment <br /> � Sewer Application and Permit <br /> � �%s <br /> 3� <br /> NO. �1.03� 4 DATE � i� <br /> , �. <br /> Service Address _-_ �' ' � � ��- Y Utility Account No. <br /> � Billing Address Cannection Permit Fee . � <br /> � City,State, Zip ` � Con�ection Fee <br /> iOwner (Mortgagor) � � Total Fee ' <br /> Billiny Name � - i <br /> j Connection By <br /> . <br /> � Address- / ; f Signed ,<< � �'/c-%%i: :'1 <br /> ! � Cust.,mer <br /> � Phone ' � <br /> I <br /> i DESCRIFTION: <br /> Lot-_ � <br /> � Block_ � - <br /> . . <br /> i Division or Addition ' � " � •' � % <br /> ; <br /> Sewer District - <br /> I <br /> ! Monthly Sewer Sereice J <br /> Remarks: 1 ; � - �. <br /> Monthly Sewer Constr. <br /> ; <br /> � `/ �•�,v,� 2' C-� � � 3 �,���Q�� <br /> � <br /> � - <br /> Approved By < < '� � <br /> � ��/Q�T C � .�4�CC . � i,t City Engineer <br /> Issued By 'C <br /> Connection By <br /> Inspection By �����u-� <br /> Date Inspected_� 2 G�73 <br /> � � <br /> I <br /> i � <br /> SEE SKETCH ATTACHED <br /> INSPEC1lON <br />