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everett <br />e <br />City of Everett <br />Engineering Uepartment <br />Sewer Application and Permit <br />�-��, <br />NO. L �.�;� . DATE <br />ServiceAddress ���� ��/�FP <br />Billing Address Se4�+ F <br />City, State, Zip �vfR,�����Ch� �oG--� "! <br />Ownec (Mortgagor) <br />Billing Name SA'm /- <br />Connection Bys � �rY `� 6�,F,g FT'f <br />Address_ <br />Utility Account No. <br />.i �r „�—� �'p <br />_ <br />_�_ .��.�-.s <br />� <br />Connection Permi t Fee_ �! a ti� <br />Connection Fee <br />Total Fee J./fi.v f <br />Signed <br />Custamer <br />DESCRIPTION: ,; Sewer District <br />Lot � �' 7 ' <br />Block �S _ -.. -' , Monthl� Sewer Service <br />Division or Addition��..1¢T o% F�rR�=-�' � Monthly Sewer Constr. <br />SEE SKETCH ATTACHED <br />�;�,;," r, i , <br />Abutting Lot Line <br />N, S, E, W. <br />Approved By <br />Ciry Engineer <br />Issued By_S—�A-�-+� - <br />Inspection By �-�^ �'�-'�`! <br />Date Inspected Si � ' 7�i <br />NO. <��.ii %� <br />