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� /� <br />I. . � . _ (_ . - <br />everett <br />� <br />City of Everett <br />Engineering Department <br />Sewer Application and Permit <br />NO. ���0?3 / DATE . _. <br />Service Ad�ress � y/5' ���'�C��LL�� Utility Account No.. <br />Billing Address Connection Permit F <br />City, State, Zip ' Connection Fee_ <br />Owner (Mortgagor) _ Totai Fee <br />Billing Name — <br />Connection By - <br />Address ` ' ` <br />Phone - � � ' <br />OESCRIPTION: <br />Lot � <br />Block '� S" — <br />Division or Addition <br />Remarks: �/9"��/�%C <br />�yty � a`.��� <br />�,:�,��.. — <br />0 <br />�' <br />SEESKETCH ATTACHED <br />_ Signed � <br />i <br />Cusmmer " <br />li 1'��'�'Cl: i I�JiJ <br />�— <br />Sewer District <br />Monthly Sewer Service <br />�� <br />Monthly Sewer Consv. � <br />Approved By ' ' <br />CIW Engineer <br />Issued <br />Connection 8 <br />Inspection By <br />Date Inspecte <br />1-(-�IIG lc a - <br />/ 2 - '-� ^'7 L <br />