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everett <br />. � <br />City of, E rerett <br />Engineering Department <br />Ui �( ��/ <br />� �. � �::��� <br />\� <br />J " <br />1 ��G l' ; � , <br />1 �. � � <br />.` <br />Sewer Appli�at�on and Permit <br />;, ,�, <br />NO. ,r' �_ _ <br />DATE .=.� - � � � <br />i C - / <br />� , � c � . ,.,., R 2 <br />Service Address ` <br />Billing Address__"' <br />� �� �,,_� �� <br />City, State, Zip �^' ''" '� ` `� ' <br />� l. ; :,-�� : �i <br />pwner (Mortgagor) .,� � <br />Billing <br />,,� . <br />� ,� y ,� `� ; <br />Connection By �-- �'" �` ~ �_` <br />Address .- i i: 1 1- 1_r �.�: .„'`. <br />_. _ _ :T, <br />Phone - <br />DESCRIPTION: <br />Lot _— '— <br />Block_ —_— - <br />Division or Addition_�='� <br />L <br />L� ''' _` - <br />Utility Account No._ <br />Connection Permit Fee <br />Connection Fee <br />Total Fee <br />i � �:�:: � �' , .-` -"_ --�-�-� , . <br />S19ned��- � �� � ' Customer <br />Sewer <br />"lonthly Sewer Service <br />� SEE SKETCH ATTACHED <br />lonthly Sewer Constr <br />,, '. l <br />\pproved BY <br />�i _ 1;.. A <br />City EnBinee�� <br />,.__ ri --.. <br />ssued 6y <br />r����l. f `i � ''�� <br />Connection By <br />Inspection By— <br />Datelnspected <br />