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everett- <br />� ��� �� <br />,�� <br />� � � f <br />City of Everett � `� � <br />Engineering Department , � / <br />�__ i �� �� <br />Se�+�rer Application ancl Permit <br />NO. '�U 116 � DATE �y��— 7 � <br />Service Addrzss_���2- .-. �' - : .i <br />Qilling Address �A/�-/- ___ <br />City, State, Zip � _ <br />Owner (Mortgagor! ) ' �� <br />Billing Name = <br />Connection Bv_ - - --c_'_-_- — — <br />Address_. <br />Phone__ _ <br />DESCRIPTION: <br />Lot_ - <br />_ � ; <br />Division or Addition -' - � � <br />Remarks: <br />.� <br />� <br />SEE SKEi��H ATTACHED <br />Utility Account No.___ - <br />0 <br />Cannection Permit Fee ��, �� <br />Connection Fee � <br />co <br />Total Fee / O .- <br />It�C`�PECI IU�y <br />e <br />�ewer District _ <br />Monthly Sewer Service <br />Monthly Sewer Constr, <br />Approved By N.�'t"�/ c�:t/O <br />Ciry En�jinecr <br />Issued By � <br />Connection By <br />Inspection By �� � ��2� <br />Date Inspected��� �3 <br />s <br />