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everett � i� _ �"I r 1 � ' _ <br /> � , <br /> �e �� � � � � <br /> , � �- ��, <br /> � City of Everett � � '�`'• <br /> ,� <br /> Engineering Department <br /> Sew�r Application and Permit <br /> rvo. 10 �87 DATE . J `� �`'� � <br /> Service Address �- 'i <br /> Utility Account No. <br /> Billing Address i .-- <br /> Connection Permit Fee - <br /> City, State, Zip � -' = , . - <br /> , Connection Fee <br /> i Owner (Mortgagor) i' r '� ,<� <br /> Total Fee " <br /> , Billing Name <br /> i <br /> � Connection By i:-r/ ,_ �� . <br /> - ' / <br /> � Address ' �" `� CI�- L�' � <br /> I Signed <br /> � Ph0�0 ' ' � � � Cusmmer� <br /> ` _ .; <br /> ' DESCRIPTION: <br /> � Lot -'!' _' :r- <br /> Block ' � <br /> Division or Addition � :- . - -- - <br /> � <br /> Sewer District <br /> ! Remarks: ,. �. •�. ;,•\_� Monthly Sewer Service <br /> i Mon[hly Sewer Constr._�_ <br /> , Y ,. �,c•J.i.L L.lyT 11 —�/ /� Y, �F J �' <br /> i � <br /> S W�'�`"`Y' C`�- S�c�., � APProved By <; , , _; <br /> City Engineer <br /> I <br /> I <br /> Issued By_ /"� . <br /> � Connection By <br /> Inspection By�(1 ��LC�=zc�� <br /> Date Inspected_/d/Sa j�3 <br /> :e ' <br /> SEESKETCH ATTACH[D <br /> �":`Pt<'Ti�)f,� <br />