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ever�tt <br />.� <br />City of Everett <br />Engineering Oepartmen� <br />i,� _ � � i� �- <br />Sewer Appl <br />?�7"� J� jU-/iS— �� <br />1 �� <br />ication and Permit <br />NO.�-��1-G DATE <br />Service Address <br />Billing Address <br />City, State, Zip - <br />Owner (Mortgagor) � - <br />Billing Name — <br />Connection By <br />Address ' f - <br />Phone � - <br />DESCRIPTION: <br />Lot — <br />Block_ <br />Division or Additian — <br />Remarks: _ �, �: ;q,. _ ..-�r � i <br />� � r ��-� .i r --- <br />3S- <br />L'qM'�2-tn Q,c.����.,.= <br />� <br />Utility Account No. <br />Connection Permit I <br />Connection Fee_ <br />i otal Fee <br />Siqned_ <br />Sewer District <br />Monthly Sewer Service <br />�Monthly Sewer Constr <br />.; <br />� <br />Approved <br />Issued <br />ty Englnccr <br />— Connection By <br />� <br />- Inspection By �`���`�=""` <br />Date lnspected_� �y /� 3 <br />J <br />SCE SKETCH ATTACHED <br />