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e � <br />� <br />City of Everett <br />Engineering Department <br />� <br />S��rver Applic�at3on and Permit <br />( <br />�(-2��,. <br />�'��.o _. <br />1 P � R . <br />� � .`���' <br />Np, � 12 0 9 DATE �r7r 7�V I <br />� p�'�i � T�r� <br />Servire Address ��L�—l�� ���n — Utility Account No._ — <br />' � ,[.� r <br />Billing Address ��/� ' � ` ��r"`� �� Connc�ctian Permit Fe^ �-`��� <br />/ /.� /Y' G ., <br />City, State, Zip��'�Z�j 9���u Connection Fee <br />Owner (Mortgagor)_S__�_i_�� �g� Total f-ee �`�G��� <br />Billing Name C- Cy' /G� �� <br />Connection By C!7'� QG ��-77" <br />Address Signed �%�.U` �G% ! �GY�d''?°�� <br />Custom�r <br />DESCRIPTIUN: Sewer District <br />Lot 2�_ Monthly Sewer Service <br />Block 3 `-�' L / <br />Division or Addition ✓T r✓<f,�L.l1 .5 Monthly Se�ver Constr. <br />SEE SKETCH ATTACHED <br />CUSTOMER COPY <br />Lot Line <br />5, E, W. <br />i ay L - /d�7�lu/�tGs <br />City Enginea <br />� � • G /�'��J�=A �-�� _ <br />in <br />No. 21209 <br />