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evere� <br />� <br />City of Everett <br />Engineering Department <br />Sewer Auplicat�o� and PPrmit <br />NO. �_ ' �`' .. .:, DATE <br />a� S� 7M � ^ �a/ <br />Service Address._./ <br />Billin� Address <br />City, State, Zip — <br />pwner (Mortga3or)_ <br />Billing Name <br />Connection By <br />DESCR�IPTION1:�,� <br />L.ot _kS��-�E`-I-� / <br />Block <br />Division or Addition_ <br />�r...... o......f�• <br />Utility Account No. <br />Connection Permit Fee <br />Connection Fee <br />Total Fee — <br />Signed_. cusiomer <br />Sewer D <br />Monthly Sewer <br />Monthly Sewer Constr. <br />SEE SKETCH ATTACHED <br />�,.;�,., <br />Abutting Lot Line <br />N, S, E, W <br />AppfOVed BY ��iy Eneincer <br />Issued <br />/) i/ � ����,c,,,� <br />Inspection By�L <br />Date Inspected /`��77 — <br />NO. ' .� r; � ' <br />�+��, , � <br />� s; : <br />xt ? <br />_;, a�. <br />