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evereN <br />� <br />City of Everett <br />Engineering Department <br />Sewer Appliccation cnd Permit <br />,-, ,; <br />NO. � .!. '; ._ :.' DA-i �_ <br />Service Address _ Utility Account <br />�. .. . , _ � <br />Billing Address Connection Permit Fee — <br />City, State, Zip Connection Fee <br />Owner (Mortgagor) Total Fee <br />r, <br />BillingName J��M1NI �-2:,ctiti�l��. <br />Connectinn <br />DESCRIPTION: <br />Lot <br />Block <br />Division ar Addition <br />Tvoe Permit: <br />Signed - <br />Customer <br />Sewer Distri <br />0 <br />SEE SKETCH ATTACHED <br />Nlonthly Sewer Service <br />Monthly Sewer Constr. <br />Abutting Lot Line <br />N, S, E, W, <br />Approved By <br />Ciry Enginexr <br />Issued <br />�- <br />InspectionBy -'�1�«`� <br />Date Inspected�G � -- <br />NO. '_ ' ii ;� :- <br />