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everett �� �;; O - � r ,_ <br /> e ' ���� ��, : - ., - - <br /> , <br /> City of Evereh _ <br /> Engineering Depertment <br /> Sewer Application and Permit <br /> 32511 <br /> N0. � O 11. H � DATE <br /> 2��'09 f/«.�,�" <br /> Service Address ' � : - Utility Account No. <br /> Billing Address �" �r�" -' ' - .-�i'" Connection Permit Fee <br /> City, State, Zip � ". � ' / Connection Fee <br /> Owner (Mortgagor) - i Total Fee � <br /> Billing Name <br /> i <br /> Connection By ' - <br /> 4 Jdress Signed ' <br /> Customer <br /> Phone <br /> DESCRIPTION: <br /> Lot <br /> Block <br /> Division or Addition � <br /> Sewer District <br /> Remarks: <br /> Monthly Sewer Service <br /> Monthly Sewer Cor,str. " <br /> � ? 4 <br /> ,t ,, � , Approved By <br /> (a L�O++.vl �yyl..�'i���n/U � �2 � .{� City Enginecr <br /> � � <br /> 7/¢ d� — c�" �-� � `���a <br /> Issued By <br /> � '' � 1 � � <br /> e �a>..�-...�. ' S`/a W�I•L <br /> (p'�(t G CZP � �' Connection By <br /> z t.0 S 1� <br /> Inspection By .[� '�4.-.-�� <br /> _ _ Date Inspected��73 <br /> .� <br /> SEE SKETCH ATTACHED <br /> li:5i'L�Tl��f:! <br />