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evere!t ' _ . <br /> i <br /> � � �; _ - �C��- � <br /> ;. <br /> City of Everett — <br /> Engineering Department <br /> Sewer Application and Permit � ��� 3 <br /> NO. ��O3G � DATE ` ' <br /> ' Service Address ` ' " `�' Utility Account No. - <br /> Billing Address " Connection Permit Fee - <br /> City, State, Zip ^ /� �� ' '�• • � ' � Connection Fee - - <br /> Owner (Mortgagor) '' � �� `�/ �� ` ''— `' Total Fr.e <br /> Biiling Name = <br /> Connection By <br /> Signed � � ' ' <br /> � :� °=� � <br /> AddfB55 � • �'-' Customer� <br /> ��;'� <br /> Phone - <br /> DESCRIPTION: <br /> Lot - , ' / <br /> Block �1V <br /> Division or Addition "�� ` > > <br /> Sewer District__- ' <br /> _ — Monthly Sewer Service <br /> Remarks: - ,. � ' .:. � ��� r� :�:�� , � - <br /> Monthly Sewer Constr._ - <br /> ' ! " ��� rr � " ' ' J7_ <br /> CCR <br /> Approved Dy , ` <br /> ' City en9inccr <br /> �/ C` <br /> ! `/ G c s �' si <br /> Issued By ' - <br /> Conncction By— - <br /> ; d� /��� <br /> ; — In;Nection By—[!� (Cf �''"'�"' <br /> � Date I nspected_T 3�73 <br /> � <br /> .�/ <br /> SEE SKETCH ATl:�CHED �;� .� ;-, � i� ,.,; <br />