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everett , i ✓`t � ` II <br /> i I ! <br /> I <br /> City of Everett <br /> Ent�ineering Department <br /> Sewer Application ca�d P�rr�it , �! <br /> � � . � ., <br /> , <br /> N0. ..Y ��� � ��� ��' DATE � . . _ I <br /> � <br /> Service Address Utility Accaunt No. <br /> Billing Address Connection Permit Fee ; <br /> Ciry, State, 7ip Connection Fee <br /> Owner (Mortgagor) _ To[al Fee_ _ <br /> Billing Name <br /> J <br /> Connection By <br /> Address - ' Siyned <br /> . . . Cusromcr <br /> Phone — — <br /> DESCRIPTION: <br /> Lot — <br /> Block <br /> Division or Addition <br /> Sev�er District <br /> _ Monthly Sewer Service ! <br /> Remarks: <br /> — Monthly Sewer Constr. <br /> , , <br /> _ Approved By_ ' — <br /> � Ciry 6�yinccr <br /> . �. �e-.-r..,ar � i._,ca�_7 �a_..'i�t` JYI ' . Z` - <br /> /! / / Issued By <br /> rI.,.-d" .t��LL.c4c�,4% -`• .F�'6�G C/ -�� <br /> Y <br /> ` ,. <br /> �"✓� Connection By <br /> ____--���`� - � . -- <br /> , InspectionBy '�- �'�'z�� ``�"" <br /> i� ai �f � �� <br /> . <br /> '� Date lnspected�s,�'=� 5 '�� 3 <br /> — � <br /> �— - <br /> SEE SI<ETCH ATTACHED <br />