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evereft <br />e � <br />City of Everett <br />Engineering Uepartment <br />S���Ner Application and Permit <br />� <br />NO. .�_L � � i � � <br />DATE <br />Service Address S� 2� �� C—A.V /y U[— <br />Utility Account No. <br />Billiny Address <br />Connection Permit f <br />City, State, Zip <br />Connection Fee_ <br />Owner (Mortgagor) <br />Total Fee <br />Billing Name <br />Connection By__ <br />Address � , ' <br />Signed �, ,-;.i',.� <br />Phnna -.. � " Customcr". <br />DESCRIPTION: <br />Lot <br />Block <br />Division or Additinn <br />SEESKETCH ATTACHED <br />.1�'�:'l�li'�ii <br />Sewer District <br />Monthly Sewer Servic� <br />Monthly Sewer Constr <br />Approved By <br />cn� <br />Issued <br />�onnection By <br />nspection By �' i ��� 1G?�j <br />late Inspected�����j <br />/ <br />