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, _, <br />everett <br />� <br />City of Everett <br />Engineering Department <br />Sew�r i4ppiication and Permit <br />NO. �C G O�I J`�� DATE <br />�31n2Z /iils o.��A�� <br />Service Address ' <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Name <br />Connection 3v <br />.4ddress <br />DESCRIPTIOiV: <br />Lot <br />Block _ <br />Div�sion or Addit <br />Utility Account No._ <br />Connection Permit Fee <br />Connection Fee <br />Total Fee <br />J <br />SEE SICETCH ATTACHED <br />h �'�. <br />usromer <br />Sewer District <br />Monthly Sewer Service_ <br />Monthly Sewer Constr._ <br />Approved <br />enyio�ir <br />Issued B <br />Conne:.ion By_ _ <br />Inspectir �' v ��i-l�/— <br />Date I r ed=� � j�� ✓ _ <br />r <br />