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everett <br /> e � _ _ <br /> � <br /> City of Everett <br /> Engineering Department � <br /> Sewer Application and Permit � <br /> �i :. , '7 it <br /> NO. :�. O � '��. :.'� DATE _ _ -- <br /> //�'�- �. � I I L'v�- itic� 1� � V <br /> Service Address_ _ Utility Account No. <br /> Billin9 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 /> c�5�om�, <br /> Phone -—. — - — <br /> DESCRIPTION: <br /> Lot �' <br /> Block ��� <br /> Division or Addition ' <br /> SewcrDistric[_ — __ <br /> — Monthly Sewer Service <br /> Remarks: <br /> Monthly Sewer Constr. <br /> / �('_o- Ti ���4xfic�T" �S •o.wh T�. 81 � S� Approved 8y -- — <br /> 'l'1.1``l. .)j. �.�Ca C S� � y�s,l.. C�iry En9ineer <br /> L�',r �S P <br /> —�:n._AA.,�, " ��-.-.-�..,,. ,� L��n ��.�. issued ay -- <br /> � <br /> � � G:ti,,. `G L �� `t..�.�� � t 1 L�� Conneciion By — -- - - <br /> 7�' � )9 l` Y19�.� '�' ���� � G " .t'Cc��L � ,'1! .. :��_<:[�.' <br /> —� n Inspection By <br /> �QF..-iR,c� t--� •n " d' .1 i -� fi JL-�--..- <br /> � <br /> D���_,_ Date Inspected � �� i 3 <br /> � --- — <br /> 5'cESKETCH ATTACHED <br /> � �rr, � <br />