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� . <br /> everett <br /> � r <br /> y <br /> City of Everett <br /> Engineering Oepartment �Z�~ 3 <br /> Sewer Application and Permit <br /> N0. �.O O � 7 � DATE <br /> Service Address �� 2- 2 Sh`�,� /�U F Utility Account No. 3 =� � - /��- �" <br /> Billing Address Connection Permit Fee_ <br /> City, State, Zip Connection Fee_ <br /> Owner (Mortgagor) Total Fee <br /> Billing Name <br /> Connection By <br /> Address Signed <br /> Cuslomer <br /> Phone -- <br /> DESCRIPTION: <br /> Lot _ <br /> Block ^T <br /> Division or Addition _ �1� <br /> Sewer D�strict <br /> -- A4onthly Sewer Service <br /> Remarks: �/��,� Go,.y�-e7j. .✓ <br /> y„�� � G „lv��,�¢., )� Q� � ,��� � Monthly Sewer Constr._ <br /> y "/r('i P �' �� � � APProved By <br /> Ciiy Engmcer <br /> `�/� <br /> �'" �"� ��! / — �/ - }- Issued By . .. <br /> �`L" � A-�C-dXI-� M�WV .�v-.�1 <br /> Connection By <br /> Inspection By �� <br /> Date I nspected ��/.✓�7 v <br /> J <br /> SEESKETCH ATTACHED <br />