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evere� <br />� <br />City of Everett <br />Engineering Department <br />Sewer Application anc! Permit <br />,� LN0. � '_' _ . .. DATE <br />Service Address //3�� � ��Of� �0.� �' Utility Account Nc <br />2illing Address � ' ' �' ' Connection Permit <br />City, S.ate, Zip '` �"` � f� Connection Fee_ <br />Uwner (Mortgagor)__ � Total Fee__ <br />Eilliny Name <br />Connection By <br />• Signed <br />c��ro,.,� � <br />Phone ' ' �' -- <br />UESCRIPTION: <br />Lot _ -- <br />Block_ <br />Division or Addition "� � � ��' '' <br />Sewer District <br />Monthly Sewer Service <br />Monthly Sewer Constr <br />� <br />SEE SKETCH ATTF�CHED <br />Approved <br />Issued <br />;;�;":9$ <br />City Enq�ncvr <br />Connection By <br />Inspectian ByT��-�-�^-��--�� — <br />Date Inspected C �/ � �� � <br />