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-" � .. .. . �'�� . <br /> everetl <br /> ;� � . ' .. <br /> � � �� <br /> (� fi� �- �� ., /� <br /> `� �' % , 7 <br /> Ciry of Everett �� '-� ``-�j <br /> Engineering Department `� <br /> Sew�r Qpplication and Permit <br /> � ��� 'i � <br /> N0. -G._O 1 9 7 / DATE ' _ <br /> Service Address � ' � '� Utility Account No. <br /> _ j _, ��,,.• ;. � : - <br /> Billing Address_-- .-.?__. =rr'>�--G�-'`'.�-' <br /> � . t `,. V � Connection Permit Fee <br /> %� �o,�._.' .f' __ <br /> City, State, Zip � �rt--��-!-�---�:<' ;-- -�'.<'- _1 Connection Fee <br /> + ` �� <br /> Owner (Mortgagor) '�t-=.=--" �,: , Total Fee <br /> Billing Name J . ''' <br /> Connection By_ }�:.'+ ��" '-�' <br /> Address_'".�.�r � ' Signed <br /> Cusiamer <br /> Phone • �;'�. <br /> DESCRIPTION: <br /> Lot _ <br /> Block <br /> Division or Addition_f ' � ".� �- �`/ <br /> � �• <br /> Sewer District <br /> Remarks: -� <br /> Monthly Sewer Service <br /> Monthly Sewer Constr. <br /> �'c� -� � �� � �z �,� <br /> Approved By <br /> �- - <br /> GC ' � ' C�ry Engmeer <br /> Issued By <br /> — Connection By <br /> Inspection By � D �.��c4-- <br /> D�te I nspected '`� G�7 3 <br /> .� <br /> SEE SKETCH AiTArHED <br /> IiVSPECTIO�d <br />