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■i <br />evereat <br />� I _ <br />� � ,' ) � <br />City of Everett <br />Engineerir� Den=rtmPnt <br />S�wer r4��lic�,�tic�r� and Pe,ranit <br />NO....U': i =: <br />DATE i --- �� --- : .:; . <br />Service Address 'i � " / <br />E3illiny Address - =1��' ::'-L' <br />_._,. . <br />Cit�r, State, Zip — � �F. j;.. ;` ,',' <br />Owner (f✓lortgagor) �^ .'_�. �� ;r.S1�0.� �.I,_= <br />BillingName � /_ (�`-(�r"'l='A�'.f_-_. <br />Connection By 'i2�-��i_.�._. <br />Address_ '='�' �/r-�r: ?�'� __ <br />Phone_. - <br />DESCRIPTION: <br />Lot � ' � <br />� Block `' � <br />Division or Additiun <br />Remarks: <br />, ..--�.-i.�_ /��! • , r � , ... <br />_�., ,, . _ �, ,.�, s - <br />�.�.. . , ��%�r" ��T __l_L.�� ] <br />�� .—(�.-+ —���'_�.a��� r>✓ . <br />T S. r C' ,n in Y.. / - <br />SEE SKETCH ATTACFIED <br />5�211 <br />.__.___...- <br />Utility �ccount No. <br />Connection Permi; Fee ! � � <br />Connection <br />Total <br />i <br />Sianed : ,+� i �' <br />a::��-�,,,� <br />Sewer ��istrict___ <br />Monthly Sewer Ser <br />Monthly Sewer Constr. _ <br />„=�d� Approved By • ( • —_---- <br />City Fnginecr <br />;; <br />'�'P-�, Issued Bv •--� � ' - <br />Il�1SPEC � ��� <br />COIlflf:CilOf1 <br />t_ <br />Inspection By ��ut.� � <br />� Date I �spected ��� � `f _ _ <br />� <br />--I <br />-- _ _. <br />- �..�_� - ---s.r-� -- — - <br />