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evereJt <br />� <br />City of Everett <br />Engineering Uepartment <br />Severer i4pplication aro�d Permifi <br />NO. A,,_,,_ _ . � DATE — <br />. --� • <br />Service Address��' Utili.y Account No. <br />Billing Address__ y `� ` Uonner.t.on Permit Fee - ^` � <br />i <br />City, State, Zip Connection Fee <br />Owner (Mortgagor) — '' " ' 1J, Total Fee <br />Billing Name <br />Connection By ' � �` -•' �� f� = -- <br />Address � ' '= �'- Sig <br />Phone <br />pESCRIPTION: <br />Lo[ _ <br />Block <br />Division or Addition <br />Remarks: <br />J <br />> — i : <br />' ' � , �` <br />� � Y��_�' . <br />J � <br />,':�/ / i�l ; A 1 C d,.l. C.r .-C- !�]/ <br />. r <br />/1 �� ��l� i. '-:�V/�. �:'J i; r.: <br />,. ; r ,y._ <br />'.�', �� _ i.. i.+�:. .;c.,ecr�..�-> • _ <br />SEESKETCH ATTACHED <br />Cusromcr <br />Sewer District _ _ _— <br />Monthly Sewer Sen�ice <br />��onthly Sewer Constr. <br />Approved By_ _ -- <br />Ciiy Enyinevr <br />ISSUCd BY — - -- <br />Connection By <br />Y' <br />Inspection By <br />Date Inspected __ <br />