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everett <br />� <br />City of Everett <br />Enqineering Department <br />S���r qppli�ation c�n� P�rr�nit <br />NO. =— DATE <br />�-- .r,� <br />� %� `-- <br />� <br />�^ �' " 2�`.�5 . <br />Utility Account No. — <br />Service Address <br />Connection Permit Fee <br />Billing Address <br />Connection Fee <br />City, State, Zip <br />Total Fee <br />Ovaner (Mortgagor)�--------- <br />Billing Name -- <br />Connection By <br />$i9�ed— Cus�omer <br />Address <br />Phone_--- <br />Sevaer District — <br />DESCRIPTION: <br />Lot — Monthly Sewer Service <br />Block_.--- �_ Monthly Sewzr Constr. <br />Uivision or Addition <br />5EE SKFTCH ATTACHtu <br />Lateral <br />�butting Lot Line <br />N, S, E, �N <br />approved By ���y Engineer <br />Issued <br />Inspection <br />Datelnspe <br />NO. �'�__fFil^ <br />