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everett l � I Cj _Z�� � rj - _ . - <br /> � �� <br /> City of Everett <br /> Engineering Depertment <br /> Sewer Application and Permit <br /> . d,0074 ' � : ;,; <br /> 32423 <br /> NO DATE �j��� l ;,'�'. � ' <br /> � - __ _---_ _---------- -- <br /> Service Address ��%� � � ' � � " �- Utility Account No. <br /> �•-'; ' Connection Permit Fee -' `�'�- �� ' � <br /> Billing Address ' � . -� <br /> ; - �'r� � l Connection Fee - --- J- - ---� <br /> City.State, Zip < <�(^�� i � " / , �, � C <br /> . , � � i <br /> Owner (Mortgagor) �"'/�����r <br /> �� ;;. . �i,, ` ;j�atal Fee � � <br /> , ����::�;' <br /> Billing Name <br /> Connection By` •�� ; �p 7 � —' ��`"' <br /> Address 'i �-�- "`�` { ~ Signed <br /> Customer <br /> Phone � �— - � � : <br /> DESCRIPTION: <br /> Lot � ' <br /> ,. <br /> e�o�k - _ _ ._.T <br /> Division or Addition '� " � � <br /> Sewer District <br /> Monthly Sewer Service <br /> Remarks: ). , - � L, � . ':;� �j�/i - - - --- <br /> — � ,:i Monthly Sewer Constr. <br /> .',< -% .- <br /> - --- i <br /> lo '�L'co�wo���. �n_a.�,,.� S 3%= Approved By � .� �'�:,-(.� (� (� . � <br /> CitV Enqinter <br /> ����— !�_— ' . <br /> �� ��� L : <br /> Issucd By <br /> ( " c�� sd� � —7 ' Gf� 's <br /> �_�-�.� �� . Connec;ion By-- <br /> Inspection By � r' '�"`� <br /> Date Inspected � � ��< ��� � <br /> � <br /> SEE SKETCH ATTACHED INSPECI'ION <br />