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evet�tt <br />12.�� <br />City of Everett <br />Engineering Department (� ' <br />Sewer Application and Permit <br />NO.,:10402 DATE <br />Service Address Utility Account No. <br />Billing Address <br />Connection Permit Fee <br />City, State, Zip ` ! , <br />Connection Fee ---'-'--- <br />Owner (Mortgagor) ( « t.4 Total Fee S �- <br />Billing Name f> <br />Connection By Ift L C. 1- %'i''7 G` <br />Address G' 7 <br />Signed\ <br />Customer <br />Phone '- 5 Z - �// '/��" <br />DESCRIPTION: <br />Lot <br />Block_ <br />Division or Addition— /- %'i �%I S j • - S % <br />Sewer District_ <br />SEE SKETCH ATTACHED <br />INSPECT ION <br />nthly Sewer Service - <br />nthly Sewer Co:istr.= " <br />)roved 8y <br />Cny Engmecr <br />ed By �. <br />nection <br />ection By���.v <br />Inspected ///zri 1-2 3 <br />