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� everett �� — " � <br /> � � ,f7 • l � � .�`�� � � <br /> ��.�r� r:� i� (/ �" <br /> ` <br /> City of Everett <br /> Engineering Uepartment <br /> Sewer Application and Permit � <br /> � � � � z <br /> No. �:0455� DATE _ — <br /> � ' .' ; ,-; � .- _. � Utility Account No. � <br /> Service Address - <br /> Billing Address ` Connection Permit Fee <br /> _. ___ __._ <br /> City, State, Zip Connection Fee <br /> , 1 � , , ., � , _-_ <br /> Owner (Mortgagorl_ - ' � -:j .'." Total Fee - <br /> Billiny Name <br /> Connection By�� ' �� "��'-� h , -. r� <br /> ^ <br /> 7 , r. - L_% t. ✓�-�-, ,., _ <br /> Address , ' ,' ' i<=.1/(Y"_ , , i- �,: Sig�ed <br /> � � Cusromer • <br /> Phone__ <br /> ,.; ._ �: '% �S <br /> DESCRIPTION: <br /> Lot � � �� <br />� ' Block [�"� � _ <br /> Division or Addition � '= F� � r � ' �� ` <br /> Sewer Distrir,t <br /> Monthly Sewer Service <br />�� Remarks: � ✓,�' i��� 'I ��.'� ��» — -- <br /> Monthly Sewer Constr._ <br /> � <br />� ���'�� r� `2--�/ �� Sh�� `L 50 /� Approwd By � .. " - <br /> City Engincer <br /> / i <br /> ' _/�QQ. ♦ ;�( <br /> fl�.Y.4� �G o1 %,_�.� _d Issuad By "V.., <br /> Connection By <br /> I�,spection By.—.f1���'`�"'�""' � <br /> , Date Inspected���l%,�3 — <br /> � <br /> SEE SKETCH ATTACHED ,;y<;�[CTION <br /> i <br /> -� <br />