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rsvere� , <br />e�. ���� � <br />���-/�-74 <br />�, . �� � � <br />City of Everett ' � ��-j'�� <br />Engineering Department � <br />Sewer Application and Permit <br />NO. �,,ir� _ . <br />U�r'.�J DATE <br />_ � .r� � _. , ;"c;��;: � - _ ,-_ <br />Service A_dress `'�--� �'`�"� "—"""""—'J""' Utiliry Account Nc <br />Billing Address " Connection Permit <br />City, State, Zip_ � Connection Fee_ <br />Owner (Mortgagor�__ " '' 1 ' _ Total Fee_ <br />Billing Name <br />Connection By �` `�� �' ` — <br />t� =' <br />! �� <br />Address . �iJpn•,� t; u. ,�7Lr��=��, Signed ; i'' ��;� � � <br />� <br />Cusromer <br />Phone ' ---- — <br />DESCRIPTION: <br />Lot _ <br />Block = ' <br />Division or Addition_ - -- -- <br />Remarks: , q <br />fT <br />�P w-i-1 C�.�,�, � G 7� �i� //� yI S u/ <br />...�.�4ti�� i _ �/_ r <br />� — — <br />SEE SKETCH �.TTACHED <br />Sewer District__ <br />Monthly Sewer Service <br />� Monthly Sewer Constr <br />� <br />Approved By . .. ; '/, ,, i L?. •� 1 '� <br />City Engineer <br />�$SUCd BY � f <br />Connection By <br />Inspection By �.v �"��—°'`�`""� <br />Datelncpected � � ? y — _- -- -- <br />