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/ <br />evered <br />� 1 , <br />_1 r � <br />t � C" ` ��., l � �� _ <br />r <br />: �G� � <br />City of Everett /: ���� <br />Engineeiing Department <br />S��nrer Appl�catian c�nd Permit <br />N0. ;L� V � Q '' � DATE ____ <br />33��8 /�o� ,Do�g�/ <br />Service Address_ <br />Billing Address <br />City, State, Zip_ <br />Owner �Mortgagor)_ <br />Billing Name _ <br />Connectlon By_-- <br />Phone_- _ _ <br />DESCR •TION: <br />Lot _ . — <br />B!ock <br />Division or Addition_ <br />Remarks: <br />_ �I/a_ _/�.se—�s��� �- <br />Utility Ac�ount No._ <br />Connection Permit Fe <br />Connection Fee_ <br />Total <br />Signed <br />customcr <br />�7 <br />SEE SKETCH ATTACHED <br />' 11�-� -�r�r: <br />Sewer District__ _ <br />Monthly Sewer Service <br />Monthly Sewer Constr <br />Appro �ed By -- <br />City Enginccr <br />Issued <br />Connection By — --- - <br />Inspection By — <br />Datelnspected _ <br />