Laserfiche WebLink
, �_-Z� _ � <br />evetelt ' � <br />e � <br />City of Evr,rett <br />Engineering Department <br />Sew�er Applicat <br />No.a.003� <br />� <br />y .� <br />ion and Permit <br />DATE <br />ServiceAddress g�� �L-�,y <br />Billing Address <br />City, State, 2ip <br />/'79 a �- /cc �c. <br />Owner IMortgagor) — <br />Billing �Vame <br />Conner,tion 8y <br />Phone � <br />DESCRIPTION: <br />Lot _ <br />Block <br />Division or Addition_ <br />Utility Account No. � � � �� �� � <br />Connection Permit Fee <br />Connection Fee <br />Total Fee <br />Signed <br />Cusiomer <br />SEE SI(ETCH ATTACHED <br />INSPCCTIOP. <br />Sewer District <br />zs <br />Monthly Sewer Service Z � <br />Monthly Sewer Constr. <br />Approved Py ' <br />City EnBineer <br />I SSU CCI <br />Connection By <br />Inspection By� •�" <br />Date I nspected yJ "7 �/7 7�' <br />l <br />