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e�ei �tt <br />� <br />City of Everett <br />Engineering Department <br />Sewer Appli <br />No. 20935 <br />�` ��Q� �� C c%,�;_ <br />( ' �� <br />cation and Permi� <br />DATE <br />Service Adc.es <br />Billing Address <br />City, Sta'e, Zip_ ' ; <br />Owner (Mortgagor) - ' ' � <br />Billing Name <br />Connection By ' <br />Utility Account No. <br />Connection Permit Fee <br />"�— <br />Connection Fee <br />Total Fee <br />Signed ` <br />Cistomer <br />34U:�'> <br />� l� <br />DESCRIPTION: Sewer District - — <br />Lot <br />Block Monthly Sewer Service <br />Division or Addition Monthly Sewer Constr. <br />Tiunk <br />Lateral <br />o —_— _ <br />SEESKE7CH ATTACHED <br />Abutting Lot Line <br />N, S, E, W. <br />Approved B <br />Engincer <br />Issued B <br />I nspection By � � � �• � �� � '1.� - <br />Gate Inspected � � ' > ' � � <br />NO. ' <br />