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everetJ <br />� <br />City of Everett <br />Engineering Oepartment <br />I; iC/. �_�= _`> <br />, , <br />r. <br />�' <br />Sewer Application and Permit <br />N c 1'� � `� `' � //30 <br />Service Address <br />Billing Address. <br />City, Statc, Zip <br />Ownei (Mortga <br />Billing Name_ <br />Connection By. <br />Phone_—.— <br />DESCRIPTIGN: <br />Lot _— <br />Block ___ <br />Division or Additiun <br />DATE <br />No�f'Tc�N /�UE <br />_ Utility Account No. <br />UO <br />_ Connection Permit Fee ��� <br />_ Connection Fee,��^� <br />.�� i> U <br />_ Total Fee �i, `� • <br />Signed <br />SEE SKETCH ATTACHED <br />Ii�:��'"�.C'�1 IC��.�: <br />� � <br />Sewer District 3 Z <br />Monthly Sewer Sr.rvice Mr">�.e�/� <br />�� :'3 <br />Monthly Sewr.r Constr. 3 <br />Approved <br />Issued <br />e�s��o�. <br />Connec[ion By — <br />Inspection By��. C- � � (4�'a "' <br />Date Inspected � 2 — � � L <br />