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_ —' I r . . _ _ . .,_ <br /> evei�ett ' <br /> e �- � <br /> 32�72 <br /> City of Everett <br /> Engineering Department <br /> Sewer Application and Permit <br /> �+� / <br /> N0. d�O O �� 9 • DATE " � <br /> / 6 C '�,, ; ., l <br /> Service Address �70� �'�� �T Utility Account No. " � <br /> Billing Address ' � Connection Permit Fee <br /> City, State, Zip - Connection Fee ' <br /> Owner (Mortgagor) i Totai ree_ <br /> Billing Name � <br /> Connection By f � � I � � • � ? ' � n <br /> I . <br /> � , � . 4',c` Signed <br /> Address • `' ' <br /> Cus�omer <br /> Pho ie � —= ' " - <br /> DESC;�IPTI ON: <br /> Lot +' t �- <br /> Block <br /> Division dr Addition <br /> Sewer District - <br /> Monthly Sewer Service <br /> Remarks: ' " <br /> — Monthly Sewer Constr. <br /> �_C�.,,,� � �-x-<-.-f_ H �" VC --c�� a.� �v . <br /> � � � <br /> Ri � S�n J�7,!✓ 3 �i.G� c�a.: ,l�- � , �. ;, , . <br /> Approved By <br /> p City Engineer <br /> ��1�� n�CCS� a-.�c �--�� � IssuedBy --- <br /> ,{/:.lc-�-., -� — <br /> Connection By <br /> -- Inspection By �' �� ?T���'-�"`^'J— <br /> Date Inspected �;��� � <br /> :� <br /> SEE SKETCH ATTACHED r. ,�= _ •, i ��' <br />