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everen <br />� <br />City oi Everett <br />Engineering Department <br />�-� 3 l _ � f _ � _ <br />J <br />Sewer Application and Permit <br />NU. ._'LO 1 G 5 / D_4TE `� � <br />Service Address ' � ✓ -� � � '=- �''- -` �� � � � - <br />; - <br />Billing Address '� �' � %%%- "'� � " ' <br />Utility Account No. <br />Connection Permit <br />� <br />� � < <.. <br />City, State, Zip `��''� '`'+� 7 T - ' � Connection Fee - -' �•' - <br />Owner (Mortgagor) ' � ~1 � � , r' � � �' � Total Fee — ' � -- - <br />E3illing Name %f� /� ' �- � ��� <br />Connection By � � � r' ` � `' � . � - <br />� <br />�. <br />Address :�. - �y� �;n r� �) ->.: J.-i ;,, t,. Signed-� "_ <br />Customer <br />Phone - - _ < ' <br />DESCRIPTION: <br />Lot <br />Block_ <br />Division or Addition - ' - <br />� <br />Sewer District � <br />Monthly Sewer Service '- <br />-r � <br />Monthly Sewer Constr. - '-- <br />� <br />SEE SKETCH ATTACHED <br />I�i!:;i'ECi li)id <br />Approved By ' ' ' � <br />City Enginecr <br />Issued By � <br />Connection B <br />Inspection By �` �N'�`""`u�^� <br />Date Inspected ��7 3 <br />