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everett <br /> � � . � -. . i�l� � �_� <br /> i � . <br /> '/; r �� �. C" <br /> ; ,_ � �- �z .;�- � � <br /> City of Everett ; % " <br /> Engineering Depertment <br /> Sewer Application and Permit ) J�7 <br /> . �l.rr( Fi� ' <br /> N0. �O 2� 2 � DATE <br /> Service Address �'` ' � " , Utility Account No. <br /> Billing Address ' -` 'c=� Connection Permit Fee - ` � <br /> City, State, Zip=. `%� �' � l Connection Fee <br /> •, <br /> Owner (Mortgagor) . ' %15�!"'y�. Total Fee <br /> Billing Name � � '� ' ��`" <br /> Connection By - ' •`� %1 <br /> Address <br /> � ' ! S� '=.r'- ; Signed <br /> cu:tomc. <br /> _ :i� ._7 <br /> Phone_ ` � <br /> � <br /> DESCRIPTION: <br /> Lot � - <br /> Block �' `i <br /> Division or Addition <br /> � '�-�,_' i/J <br /> Sewer District <br /> — Monthly Sewer Service <br /> Remarks: - � • -' <br /> Monthly Sewer Constr. <br /> .Fs o / -z/' � <br /> — 'Q/�l /1pProved By - � %i I <br /> Ciry�Engineer . <br /> Issued BY �!- <br /> Connection By <br /> Inspection By <br /> Da[elnspected <br /> �' <br /> SEESKETCH ATTACHED <br /> IPJ���PECTI4N <br />