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u <br />everett — <br />� �lJ`..-L-e"' Q/"�;) � - \ <br />�i,_' ;'�� <br />City of Everett <br />Engineering Department <br />Sev�ver Applicatior� and Permit <br />-, . <br />�; �, ... '9 4 <br />N0. - . DATE <br />Service Address 3��`"�� F� �� ���-`- F CC L�� Utility Account No. <br />Billing.4ddress � Connection Permit Fee <br />City, State, Zip Cannection Fee <br />pwner (Mortgagor) Total Fee_ <br />Billiny Name <br />Connection By � <br />Address Si9ned —__— <br />c��.����,,,, <br />Phone --- <br />DESCRIPTION: <br />Lot _ <br />Block_---- <br />Division or Addition_—_ ----- <br />Sewer District__ <br />Morthly Sewer Service <br />Monthly Sewer Constr <br />� <br />SEE SICETCH ATTACHED ��,-. . <br />au��o��d ev_ — -- <br />� c��v e���m,�•��� <br />I ssued <br />Connection By <br />Inspection By�� � — <br />Date Inspected �`�/ � `� -- <br />