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I� <br /> 7 <br /> everett � , r � �%f_ � <br /> C�� -r �' - _ <br /> e � ;�- <br /> ; <br /> City of Everett <br /> Engineering Department , <br /> Sew�r Application and Perm�t <br /> 3ti564 <br /> rvo. 1014 6 � DATE � <br /> Service Address�L/G`(G G,�'f}�//] Utility Account No. <br /> Billing Address Connection Permit Fee " <br /> City, State, Zip � � -' ` ' Connection Fee <br /> Owner (Mortgagor) Total Fee <br /> Billing Name ' <br /> Connection By <br /> `� Signed <br /> Address c��s�o�,�� <br /> Phone <br /> DESCRIPTION: <br /> Lot <br /> Block_— <br /> Division or Addition,_ ' <br /> Sewer District <br /> Monthly Sewer Service <br /> Remarks: �r�i�v 2 - <br /> Monthly Sewer Constr. <br /> �+6-�.--dL �-d=�-- ct-�,9- - � <br /> Approved By ' <br /> � �o �9 Ciry Enginccr <br /> �(.�LGi-fl-d� S.C'Q�I?��-� �� ` U-�����a�. ti,..�-� �•,t . <br /> l — ...i �SSU@C� BY <br /> / b � ��,�,,.� t �-' �� ' Connection By <br /> Inspec[ion By—,�-/ ��'� '�� t�'"� <br /> Date Inspected��7 � <br /> � <br /> SEE SKETCH ATTACHED ��,��;�r_cTluN <br />