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1 <br />everen <br />� <br />.—� <br />City of Everett <br />Engineering Department <br />Sewer Ap�lica�ion and f�ermit <br />N0. �.� L' � `! � DATE - L-- <br />Service Address � � _�� ��FF�l�2 Utility Account No. <br />Billing Address <br />Connection Permit I <br />City, State, Zip Con�ection Fee_ <br />Owner (Mortgagor)_: Total Fee <br />Billing Name <br />Connection By <br />:.��.39 <br />� <br />Address_ Signed — <br />Cusiomcr <br />Phone �' �� <br />DESCRIPTION: � <br />Lot <br />Block <br />Division or Addition <br />Sewer District <br />'Vlonthly Sewer Service <br />Vlon:hly Sewer Constr <br />SEE SKETCH ATTACHED <br />�-- — <br />s� <br />_� <br />Approved By � - <br />Ciry Enginccr <br />Issued 8v ' ` <br />Connection By <br />Inspection By_ ��' C`�1��`f`=� <br />�-y-�z <br />Datelnspected._�� <br />