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eve►�rtt � - 3 � � Z �%-S <br />City of Everett <br />Engineering Department <br />Sewer Application and Permit <br />NO. 10300 <br />DATE -J1-� -1 ` --- <br />Service Address `4 --• - > I , Utility Account <br />3 - I� <br />Billing Address t,� �L '�--- Connection Permit Fee <br />City, State, Zip—Irl <br />__ Connection Fee <br />Owner (Mortgagor) '—\ `2v -A-t ', Total Fee 1 <br />Billing Nan.et <br />Conne lon By <br />Address 1 \'V 1�11�\ l �.)�11t�14�. `'• Signed_ <br />Customer <br />Phone `�� _ 7t ) 7 a- <br />DESCRIPTION: <br />Lot �'— <br />Block - <br />Division or Addition �-c\ \2RS •- `�C% f <br />Remarks: <br />I, p ta,G <br />(''f 4- <br />SEE SKETCH ATTACHED <br />INSPECTION <br />Sewer District v �\_-- <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Approved By 1\N\ <br />City Engineer <br />Issued By <br />Connection By — <br />Inspection By '0 <br />Date Inspected —A? /73 <br />