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� everett <br />�e <br />i City ot Everett <br />Engineering Department <br />��_ ' , J <br />� c / �� <br />, n L'I �i.� <br />, �l <br />�� <br />�, <br />Sew�r Appiicati�on and Perrnit <br />rvo.:10��9 <br />, <br />DATE <br />' — �,� � ' <br />_ � ,� <br />f =i :�;1..4- !�,?% �r ' Utility Account No. - ,` <br />Service Address / .�� • ! , ��{ � � ,-. <br />� .. �l : � J � �/ � <br />� Billing Address � ' �— '�'�� "tt��"Nf!i `!'%" ' Connection Permit Fee '� � "� <br />, <br />i; , i <br />' City, State, Zip ' �'� � 'T , '�`/I � � i, `'-. �' Connection Fee - <br />� •, � -, . <br />IOwner (Mortgagor) - '� < ' � � ��' `' �` Total Fee ��r � � ;- i <J <br />� ; .- <br />' Billing Name ' �_ <br />`� � , �� -- - ' - <br />Connection By � ' �� r •; ' ' ; ' ` ' <br />� ,.. . - . , � i_-. : -- <br />Address % �!;� ' �.' ,'.'�/'�=� f = i%� : � � . � Si ned � <br />i 9 Custamer <br />Phone - <br />DESCRIPTION: <br />Lot <br />Block <br />Division or Add <br />� <br />SEE SI<ETCH ATTACHED <br />IN:>P�CIIOf� <br />� <br />I.. ' :'- J� � .�j'/, �. <br />Sewer District <br />;; ,_- :_ . <br />Monthly Sewer Service ` � " � <br />Monthly Sewer Constr. ' / <br />:! .- �..- �, �� ��'� <br />Approved By ''� •;; -'' - <br />City Engincer <br />Issued Bv <br />Connection By <br />I nspection By �� • � �-*��"`"""`' <br />Data Inspected_L ���� <br />