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, �. <br />everelt <br />� <br />City of Everett <br />Engineering Department <br />Sewer Application <br />N� „1 � j j ) DATE <br />Service Address � <br />Billing Address <br />City, State, Zip <br />pwner (Mortgagor) ' <br />Billing Name <br />Connection B1� <br />Address � <br />Phone ---- <br />DESCRIPTION: <br />Lot <br />Block <br />Division or Addition — <br />„ � <br />� <br />� <br />and Permit <br />a <br />Remarks: � � ' <br />'� '�awa � 6'� �`—�4=X--Z� <br />U'��C�.C� l.� .ow�..t /�L'.Gi.cn � � �.uR <br />SEESKETCH ATTACHED <br />Utility Account No. <br />Connection Permit I <br />� <br />Connection Fee_ <br />Total Fee <br />Signed c _ ,—. <br />� <br />Sewer District — <br />Monthly Sewer Service �u/L <br />Monthiy Sewer Constr. <br />��,, !'— �A/L� <br />� . <br />Approved BV ,' [. � � , i <br />Ciry E�9�neer <br />"`.'( <br />Issued By ` � <br />-- Connection By <br />Inspection By___�2-� "-" "s`�� — <br />Date Inspected yl � y� - --- <br />��r, , <br />