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�verelt , � ��, '�- � - � <br /> � `I ) �>�1�,c4/ '��i! ; �-%.. ;% <br /> �; J, I ' <br /> City of Everett <br /> Engineering Department <br /> Sewer Application and Permit <br /> No. 10478 DATE J�i ' . � � ' ' ' <br /> , �3tii9 <br /> . <br /> Service Address �' �' ' � `_ Utility Account No. ------ <br /> Billiny Address Connection Permit Fee - '-� <br /> City, State, Zip___, % ;- �'' �-- 7--� Connection Fee <br /> Owner (Mortgagor) � {K J. •1 'Ol h' �t� �... � <br /> Total Fee - <br /> Billing Name <br /> Connection By_ ' '-�=h j< � � ' + <br /> - � ; ,-_ _ , � <br /> Address �_'✓!�1 � ' _ -' �r- . Signed— �` �c _ .;.,.. ' � � : <br /> � Phone � `/-- ' / ' � � c�:com�� � <br /> �. <br /> DESCRIPTION: <br /> Lot_ ' <br /> Block f� "�-- <br /> ; Division or Addition - = r;' r-' : -� ' �� r ' � <br /> ;ewer District - <br /> ' Remarks: , � /�? � -�-� �� � Monthly Sewer Service ' -' <br /> iVlonthly Sewer Constr. - � ' <br /> �� �- �'�� a � % � s �z �-.,� , . <br /> Approved By . r'. , : / ' � !� : l <br /> �, City Engmecr� <br /> /� Issued By �, ' " <br /> - Connection By <br /> __ Inspection By �✓-7i�-��.,,.,_, <br /> i <br /> Date Inspected�����7 y <br /> .Fi <br /> SEESKETCH ATTACHED <br /> . INSPECTI(iIV <br />