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C <br /> everett �j_ � <br /> i � � � Jr <br /> � � � � � `��-� ��� � <br /> � l � �, r <br /> , ���������:a, <br /> City of Everett <br /> Engineering Department <br /> Sewer A�plication and Permit <br /> J :i � �z <br /> No. �'_0538 DATE � r" - _, , : <br /> i _ <br /> Service Address ' S - �` �='� ' ' " - Utility Account No. - — ' � =' % ' � �-' <br /> / . <br /> Billing Address �`"' Connection Permit Fee "- <br /> � <br /> City,State, Zip =i - � : = � i Connection Fee . - � `- <br /> Owner (Mortgagor� '�F i�,'�s'' '' _ � -� -<,' -i Total Fee <br /> Billing Name � �% �!� <br /> , <br /> Connection By - - � ' ' ' - <br /> Address ;•� � '� 4 SS Signed - <br /> cusromcr <br /> . "r(� : ... .. ., i i. <br /> Phone - <br /> DESCRIPTION: <br /> �ot � �N�C.�qn7r' ��11 Stc . <br /> Blcck_ � g` �'C.7� <br /> Division or Addition - ' ' ''�'`= ' <br /> Sewer District <br /> , <br /> Monthly Sewer Service - _ <br /> . <br /> Remarks: - � •.�.1,_ �"<.' -' r✓' i . <br /> Monthly Sewer Const,�` '= �;b u ' �'- : ' � � <br /> � '"Ti,.', ;,`t,1 �',... � i � , i <br /> i . <br /> /� n Approved By ` - �� , � <br /> Y/'(�p` -o,,,.p � �irr ��� (i,K2: CiIYEngineer•ti <br /> p �/� .,t_ � ` Issued By `-"'--" <br /> •�/��s°C ia-�Gf' /� .�cow�. <br /> - Cannection By — <br /> Inspection By_���� ��FIQ"� <br /> Date Inspected��7 y <br /> � <br /> SEE SKETCH ATTACHED <br /> WSPi=Cfll;i�! <br />