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, <br />everpY+ <br />e, <br />City of Everett <br />Engineering Oepartment <br />� / �/G ��75 <br />, _3 ��-���� / <br />� <br />Sewer Application and Permit <br />NO.ZI O �}'�� �j� DATE <br />� �� v <br />Service Address��� `` �' <br />Billing Address � � ` ' �- �' • <br />City, State, Zip ' �—�--=: + <br />._..-_:._:�..: , . -�`1 T-�-, <br />Owner (Mortgagor�:=�. .•°' ='1'--`- — <br />Billing Name 1`—: � � � '� -� � �' � - <br />Connection By � '" -- ' '�• '' <br />Address - �" t-�_ ,1�� " <br />�,>>. � <br />Phone <br />DESCRIPTION: <br />Lot _ <br />Block <br />Dwision or Addition - <br />33(3$7 <br />Utility Account No. <br />Connection Permit Fee <br />SD � <br />Connection Fee ���v <br />Toial �ee <br />Signed <br />Customcr <br />SEESKETCH ATTACHED <br />Sewer District <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Approved By ' <br />City Engincer <br />ISSU2d Bv <br />Connection By <br />Inspection By ������ �?�"Qi^� <br />Date Inspecled�� /� �' <br />