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everett <br />e <br />City of Everett <br />Engineering Department <br />Sewer Application and Permit <br />NO. 1112 y (� <br />DATE <br />Service Address L7 G S &' /uLIC <br />Billing Address_—� <br />City, State, Zip — <br />Owner (Mortgagor)_ <br />Billing Name <br />Connection <br />Address <br />Phone <br />DESCRIPTION: <br />Lot <br />Block - <br />Division or Addition <br />Utility Account No. j <br />Connection Permit Fee �— <br />Connection Fees <br />Total <br />Signed <br />Sewer District <br />SEE SKETCH ATTACHED ,,,,f .] ��y <br />AOil Y Sewer <br />Aonthly Sewer Constr <br />Npproved BY ET v a g <br />n nicer <br />Issued <br />Connection <br />Inspection By <br />Date Inspected �;7 <br />