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CVci"t�h <br />� .�_ �-j � <br />City of Everett <br />E�igineering Department <br />Sew�r Appli�eati�n and Permit <br />rvo. 10 � � :_ <br />Service Address <br />Billing Address <br />City, Statc, Zip <br />Owner (Mortgagor) <br />Billing Name <br />Connection Bv_ <br />Address <br />Phone <br />DESCRIPTION: <br />Lot <br />Block <br />Division or Addition <br />DATE <br />— Utility Account No. <br />— Connection Permit Fee <br />—. ConnectionFee $c&-� ������, <br />_ Total Fee <br />Sign <br />SEE SKETCH ATTACHED <br />ustomcr <br />Sewer District� - -3 � <br />Monthly Sc •.e, Service_1�� �/� <br />�R 7�E-y�c. �� . ¢p <br />Monthl�� Seveer C��y�� 3. 8 J <br />/3�� /�w. Fl �7o-c9.p, L y <br />Anproved i <br />Issued Ry <br />Connection <br />Inspection I <br />)atelnspec' <br />necr <br />;;�;�z /�3 <br />