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everFn <br />,� <br />City of Everett <br />Engineering �epartment � <br />Sewer Appli��tio� car��i �s_rr±-ii± <br />; <br />N0. '- � �_ ._ _ DATE <br />//3��5 ri,� ..�-.GY �'.Cso.� o,c� <br />Service Address � _ Utility Account Nc <br />Biliing Address Connection Permit <br />City, State, Zip : ;.'� Conner.tion Fee_ <br />Owner (Mortgagor) �`-" % -% . � Total Fee <br />Billing �Vame -'�- <br />:� <br />C�nnection By � :' �'� - <br />;',, <br />Address ' '1 �- ' ` ' <br />Phone_ <br />DESCRIPI"ION: <br />Lot--- . <br />Division or Addi*.ion_ - <br />J <br />SEE SKETCH ATTACHED <br />Sewer District - <br />Monthly Sewer Service_ <br />Monthly Sewer Constr._ <br />Approved By_ - <br />City Enginccr <br />Issued <br />Connection By <br />i� <br />Inspection By_ //� %�'v�"'—� <br />i <br />Date Inspected � ��, ��' <br />