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�. __ _ . _-. <br /> I <br /> everett <br /> � <br /> City of Everett <br /> Engineerinp Department <br /> Sewrer Applicat�on and P�rmiY <br /> NO.� OJU � DR,TE L `� -- %� .; JJe:� E1f <br /> _ .i <br /> Service Address " �-�'' Utility Account No. <br /> . � <br /> Billing Address Connection Permit Fee -� � - —� <br /> � <br /> I , 1 <br /> City, State, Zip �%c �' ' � S � � � ' Connection Fee <br /> r l •.::.. F'�-1cf'.:', <br /> , <br />� Owner (Mortgagor) �.�;�r- � _ .,;��*' Tocal Fee <br /> Billing Name � ' '� <br /> Connection By <br /> Address ' _ Signed _ <br />. ' ' .. . . ... <` Cu:mmcr <br /> Phone ' _ <br /> DESCRIPTION: <br /> Lot_ <br />, Block _ /o ¢/7 <br /> Division or Addition - ______ <br /> Sewer Disvict_ <br /> i <br /> Monthly Sewer Service ` _ <br /> Remarks: Y r�j � ; .t !„ ' <br /> Monthly Sewer Constr. <br /> y BJ !� �_ c�iJ � .� � <br /> Approved By <br /> l'�/� C � Clty Engume� <br /> / <br /> Issued By <br /> �'� a _' r C/✓ �-t�` �n�t Qszw-�.�.rx.� *�'� .. <br /> Connection By — - <br />� <br /> �i �,.,Z'!� /1 � -�L � - � �- <br /> Inspection By �' ��-�'�-«� -- <br />� �j p�.� ��,� Date I nspected / - Z n ` � y <br /> :el <br /> SEE SI<ETCH ATTACHED <br /> i icp:-�,i � <br />