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evere� <br />e <br />City of Everett <br />Engineering Department <br />� ,���;�� <br />-,- <br />; ; _ : ��_ , <br />� ' " �yJ <br />Sewer Applicatian and Permit <br />N0. ,� �_;; �''�' DP,TE <br />�c�,28 C(✓ I i/Mi�va Ton/ <br />Service Addrecc <br />Billing Address <br />City, State, Zip _ _ <br />Owner (Mortgagor�_ <br />Billing Name <br />Connection By S j J�.� ��%G c L�,� ; t t d�;c <br />Address_ `� 31 � _��AD�,,�,� 1 ✓ <br />"'�'-- <br />� <br />Phone_- ° f 1- ` �j <br />DESCRIPTION: <br />Lot �,._�_ <br />Block <br />Division or Addition <br />Type Permit: <br />R.:narks: <br />SEE SKE7CH ATTACHED <br />'r�� r��:� <br />Utility Account No. <br />Connection Permit I <br />Connection Fee_ <br />Total Fee <br />Signed _ <br />Custemer <br />Sewer District <br />Monthly Sewer Service <br />_ Monthly Sewer Constr. <br />'— Trunk <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />Approved By <br />fity EnQineer <br />Issued <br />Inspection By_ �f(/1%O�f��--! __ <br />Date Inspected 5 L � <br />/ <br />NO. < <': <br />