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-everett ' � �I � �� �; <br /> ���` � � �� i �$' <br /> � � ' � � � <br /> I � ' � ( <br /> l� ''�' � / �����`'/.., <br /> City of Everett <br /> Engineering Uepartment <br /> ' Sewe�r App�lication and P�rmit <br /> 331_ 6i. <br /> �� 0 4 4 9 ' DATE .�i���` �_: , � i `� <br /> NO.EL / - <br /> .r _.. <br /> � Service .lddress � ' `*��� - Utility Account No. <br /> Billiny Address Connection Permit Fee__'" <br /> I __ . <br /> City, State, Zip_ Connection Fee <br /> ; j .���, <br /> Owner (Mortgagor) �� i� _ Total Fee - <br /> � Billing Name - <br /> � . _ � ._ � . <br /> � <br /> Connection By ''���'� - <br /> Address � -'�'J � " � " `�� Signed �� <br /> cu:tomcr <br /> i � .�—"1 ` -/ � '/ <br /> ' Phone � � �' ; <br /> DESCRIPTION: <br /> Lot ' - =' <br /> Block ���7� _. <br /> Division or Addition ' � T - � `� — <br /> Sewer Distric* <br /> , Monthly Sewer Service - - <br /> Rema�ks: ., �.: ;�.+/(-r __.._. <br /> Monthly Sewer Constr. — <br /> �a `� '� � y � S G� <br /> � y <br /> 1 � Approved By ��1. � � !� = ' c �,�,�i�.) <br /> ! Ciry Gngiiiecr <br /> I � <br /> i '- <br /> Issued By = ' ✓ ' <br /> � Connection By— <br /> Inspectiun By ���/��'�""', <br /> Date Inspected ��y��`� <br /> � <br /> SEE SKETCH ATTACHED ,. , . - <br />