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everett <br />� <br />City of Everett <br />Engineering Oepartmen[ <br />Sewer App{ication and Permit <br />N0. i_.J .L i: ;' � DATE <br />��, <br />o.;i�C;ti <br />Service Address Utility Account No. _ <br />Billing Address __ Connection Permit Fee <br />City, State, Zip Connection Fee_ /✓D% /GLW' <br />Owner (Mortgagor) � � � � � � Tot.il Fcc_ <br />Billing Name <br />Connectior. By ' _ <br />Phnne_ ._ _ .. --- <br />DCSCRiPTION: <br />Lnt <br />Block <br />Division or Addition <br />Remarks: , <br />S' . . c'-�1 �' �'<,�, G�,..� �ia <br />� W e�� _ <br />y- �l�1. � s �i c� � l <br />.. . . .r– _ n ' - n U _ <br />S <br />Siyned_...— -- <br />c�: �����,,, — <br />• I <br />SEESKETCH AT�ACH[D <br />Sewer District <br />Monthly Sewer Serviu <br />Monthly Sewer Consir <br />An��ov�_�i eY <br />c i�- e�,�r.�.,..., <br />Issued By <br />Connection By.._ __ <br />Inspection By � � ��c ��=6�--� _ <br />Date Inspecled "� 'Z�_�3 ____ <br />