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everen <br />� ,� . <br />City of Everett <br />Engineering Department <br />„ : <br />�- � � <br />� �- <br />� :,� <br />,, , <br />� <br />Sewer Application and Permit <br />rvo. :10 2 7 3� DATE <br />G52 S l=/o�ri ir�� >> <br />Service Address Utility Account No. <br />Biliing Address � �'a� `� l'"������G= Connection Permit I <br />City, State, Zip Connecr.on Fee_ <br />Owner (Mortgagor���LL/AM A-/1/U Total Fee <br />Billing Name <br />Connection By <br />a <br />Address Signed <br />� Customer ` ' <br />Phone ' <br />DESCRIF'fION: <br />Lot <br />tlIOCK <br />Division or Addition <br />SEE SKETCH ATTACHED <br />lr;SPEC; �0� i <br />Sewer District <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Approved By <br />Ciry Engincer � <br />Issued <br />Connection By <br />Inspection By <br />.L1/ . ����_�-tw <br />Date Inspected�z� <br />