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,..,�� <br />everett <br />w <br />�J <br />City of Everett <br />Engirecriizg Department <br />���er P�►�pl��atso� and P�r�i� <br />fJO. <br />DATE <br />� a�. <br />:iervice Address ' � <br />Billing Address_ <br />City, State, Zip_ _. <br />pwner (Mortgagor) <br />Billing Name — <br />Connection By <br />Phone <br />DESCRIPTION: <br />Lot <br />Block _ <br />Division or Add <br />Type Permit: <br />Remarks: <br />%�S � �2 5 /.�� i e � <br />SEE SI<ETCH ATTA'�HED <br />Utility Account No. <br />Connzction Permit I <br />Connection Fee_ <br />Total Fee <br />Signed_ <br />Eewer District <br />Monthly Sewer Service. <br />Monthly Sewer Constr. <br />Trunk _ <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />Approved By_ <br />City Enginecr <br />I ssued <br />Inspection By �� / -�'� � <br />Date Inspected G— v�--- � r — <br />�� o. <br />