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evrre:t <br /> � - , - , <br /> � / 'r�� <br /> ,� , /� -,�- <br /> , - _ <br /> City of E�erett ' � �� � �_- <br /> Engineerng Uepartment � � <br /> S��nrer Applicatio� and Permit { (� <br /> l , <br /> U V f� LI Z <br /> _. . ,, ,, r . , � ' <br /> NO. �l�� '�I `; `� � � DATE <br /> Service Address��� �'��-- Uti�ity Account No. <br /> Billir.g Address -',' " Connection Permit Fee <br /> , _-- <br /> City, State, Zip � � ' ' Connection Fee " <br /> , ,!,'� �; <br /> Owner (Mortgzyor)_ -==`�. Total Fee___ ._ � _. <br /> r � <br /> Billing Rame_ _ <br /> Connection 6y_ -- <br /> Address_ ��: __ Siynecl — <br />� c���:,��„��� <br /> r Phone____ -__—_ <br /> DGSCRIPTiON: <br /> Lot__ — <br />. Block �— <br /> iDivisic�n or Addition ___—_.-----__—_ — <br /> I Sewer District __. —_ <br />` Monthly Sewer Service ` <br /> I Remarks: <br /> Monthly Sewer Constr. <br /> � � wP � �7 SO,Y . <br /> � � � ,�L Approved By - <br /> / City Enginccr <br /> � f <br /> �_� Issued By_ —_ <br /> _-- — — Connection f3y_ - <br /> - I nspection By � �`/`C '' << `�kG�' <br /> Date Inspected_���_`� — <br /> � -- <br /> SEESKETCH ATTACHED <br /> � <br /> � <br />