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�verett - - � <br /> ' � _ <br /> i <br /> City of Everett <br /> Engineering Department I <br /> Sewer Applicntion and Permit <br /> � z� sz <br /> N0. ��.� O J ( `� DATE <br /> 32c� c�; .��s <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 /> Address Signed ' <br /> c.,;������ <br /> Phone <br /> DESCRIPTION: �p <br /> Lot ..� <br /> _�- � <br /> Block <br /> Division or Addition <br /> Sewer District__ <br /> Remarks: Monthly Sewer Service ` � <br /> Monthly Sewer Constr._ � <br /> �l-,tn}t-1 �: 'hyc-cQ J'/ � C�...� � ci.C.l7t+.� <br /> _!o_`�j_� 3 �zf (J�-�rj --� <br /> � Approved By <br /> Ciry Engincer <br /> --- Issued By <br /> Connection By— <br /> Inspection By ,tl1� � � � -'ict,.✓ <br /> _ Date Inspected �/zc.���7 _ <br /> � <br /> SEESKETCH ATTACHED <br /> � <br />