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ever.ett <br />�e ;- - - � <br />-, z��-- �r-� <br />, <br />City of Everett �- 1 <br />Engineering Departtnent <br />Se�+ver Applicati9n and Permit <br />N0. -!. �� i� ; J DATE <br />Service Address " <br />Billing Address <br />City, State, Zip <br />Owner (Mortgayor) -" <br />Billing Name_ _ <br />Connection By <br />Phane <br />DESCRIPTIOfJ: <br />Lot <br />Block <br />Division or Addit <br />- Utility Account No.. <br />Connection Permit F <br />Cennection Fee_ <br />Total Fee___ <br />/, ��� . _ . <br />�� -: C�, <br />�l�^ ? g� � <br />_ ____, <br />_ ._�_-�._ <br />_- _ <br />__:� <br />Signed <br />customer <br />� <br />SEE SKETCH AT'fACHED <br />Sewer District <br />Monthly Sewer Service <br />Monthly Sewer Constr. ' � _ <br />Approved By <br />Ciry Enyincer <br />ISSUCCJ BY <br />Connection By <br />Inspection By � t!-G'��au<�� <br />Date I nspected ��� �� 3 <br />