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I <br /> . . - - � <br /> everett <br /> � � ��, ' i� � � <br /> ✓ :� <br /> , , <br /> Cit�r of Everett <br /> � �� , _ <br /> Enyinocring Department <br /> $ewer �pplication and Permit J � ��,€ <br /> ,-. <br /> NO. :,:.0 .�77 D��TE - <br /> Service Address `���' " --==—=-----', Utility Account Na _ <br /> Billing Address ` � Connection Permit Fee -.� <br /> City, State, Zip ` � =- '` "� '� ` ' Connection F2e <br /> - � ' •, / Total Fee__ � <br /> C�vner (Mortgagor) -`• " <br /> Biiling Name - <br /> Connection Ry <br /> _ : <br /> � ' Signed -- <br /> ,�{(fCJfC55 . , Customer <br /> Phone—. — <br /> DESCRIf'TIUN: <br /> Lot._,'.---- �(' <br /> Block_.—.-- � <br /> Division or G,ddition ' — '' � ' <br /> Sewer District <br /> D <br /> Monthly Sewer Service �. " — <br /> Remarks: . : `: [ ; ` .�i ��j� <br /> — � L y Monthly Sewer Constr. � p <br /> �{ '` �� G�. 6 �� <<T �rJ:�.� 2 7 _ ., � , <br /> APPfOVBd BY �•iry Enqincer � <br /> ' 'c..�5 P �,-L.�.�.�.. � ,lti�,..,.� <br /> �1' � -a-t— <br /> — Issued By , <br /> ' — Cannection By__- <br /> Inspection By <br /> ✓- � �ia/� cF� n� <br /> Date I nspected �'��3� '� � -- <br /> :�. <br /> SEE SKETCH ATTF�CHED IDISPECTIO�I <br />