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everett <br />e <br />City of Everett <br />Enpineerinp Department <br />Seaver Application and Permit <br />N0. ! DATE <br />Service Adc+ress � 'y ,�i �f�Y � [2,kQ %�1 ✓� <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Name <br />Connection By <br />; �.:,.Z� .� � /' <br />Address <br />DESCRIPTION: <br />Lot � <br />Block_�_ <br />Division or Addition <br />Type Permit: <br />��� � r=' .� . l! <br />�,/ - 3 S ._ z �J � r <br />� <br />�, ��; � �', ,i <br />� <br />Utility Account Nc <br />Connection Permit <br />Connection Fee_ <br />Tote! Fee <br />Signed <br />Customer <br />Sewer District <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Abutting Lot Line <br />N, S, E, W. <br />Appraved <br />Issued <br />Inspection By �� vwL•'��' <br />Datelnspected 3,Z-�'�7 % _ <br />NO. " . . <br />