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eve ���..� .�� z/�jS <br />� J � <br />� - 20 ��— 5 � �"_ <br />City of Eve►ett <br />Enpneeriny Dep�rtment <br />Sewer Application and Permit <br />��� � 2 0 7 �l 1 `; , �' ����� -� . _ r.; . <br />N0. DATE <br />� / J� <br />" : .� (1,..� �;�— � ! �r ' i <br />Service Address �-`C� 1, I •'.� � . 4-: rj,�� 4'���,,� Utility l�,ccount <br />Billing Address ' ��`� � <br />City, State/Zip � '� �` �:- c'-„I � I �_ � � �_,1 <br />` � -,"" � = f , ' "i � l ` „ <br />Owner (t�lortgrgorl� `�'_ <br />, � _-','I _ <br />� � i , .,-�. � <br />� Billing Name_ . - �: ' �� �_� '� %" <br />__ - ..� . . � �%.j � �l <br />� 1 � <br />C.O ECtlOfl BY � I '- r/ —' <br />, <br />Connection Permit Fee � " � <br />Connection <br />Total <br />� Address_ ' �' � - Signed � l � ` <br />us[amer <br />DESCRIPTION: <br />Lot _ ' <br />Block <br />Division or Addition _ <br />SEE SKETCH ATTACHED <br />IP151=Ei.IIOP: <br />Sewer District <br />Monthly Sewer Ser <br />Monthly Sewer Constr. <br />Trunk � <br />Abctting Lot Line _ <br />N, S, E, W <br />Approved By '-- <:� � �. ,, ' ', i •. <br />City Enpineer <br />ISSUCd <br />Inspection <br />Datelnspected <br />� <br />�,/% : .' � `� � <br />J � ! <br />No. 20771 <br />