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- ,, .,.. . <br /> everett / , ,y O ` ' ". - ./ <br /> � � /.. � <br /> City of Everett <br /> Engineering Uepartment <br /> Sewer Application cnd Permit <br /> J �:i� 1ts <br /> rvo. �.�7 2 3 6 DATE <br /> Service Address • � � 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 /> ` :�•.-' �"'<--- �=.:c..�.-.. <br /> Address Signed 4i' �� f , � � <br /> ' ' ` ' Cusromer <br /> Phone ' " <br /> DESCRIPTION: <br /> Lot <br /> Block ' <br /> Division or Addition <br /> Sewer District_ _ <br /> Monthly Sewer Service <br /> Remarks: '� ' <br /> Monthly Sewer Constr. <br /> '�,. G.,,� .�o � ` L�. ' <br /> Approved By <br /> A Q /J/� ` vIQ�C'4. �Q l / /�� CitV Fngineer <br /> C:./� QJc.x.t_�` /( �i <br /> � � "f"'�-�� — issued By <br /> �-- <br /> ,�^`�°Q _1--��`"{=z�.;-s-� 7.'��"z-��J�'-`= Connection By <br /> Inspection By ��G -"�`^—� <br /> Date I nspected S�/�,�— <br /> � <br /> SEESKETCH ATTACHED <br /> I�',IFi'�.. I-I(��. , <br />