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City of Everett <br />Engineering Department <br />Sewer Application and Permit <br />NO. ;Z017 5 DATE <br />�� <br />Service Address_ '7 7 3­3 `n J LZt -- <br />Billing Address f <br />City, State, Zip <br />Owner (Mortgagor) —_% = <br />Billing Name Lr <br />Connection By_ <br />Address <br />DESCRIPTION: <br />Lot <br />Block - <br />Division or Addition <br />Remarks: �• ,�.:_/•� �/ <br />0 <br />Utility Account No. <br />Connection Permit I <br />Connection Fee_ <br />Total Fee_ _ <br />Signed i '` �r(1/ C A-) merit !/ <br />Customer <br />SEE SKETCH ATTACHED <br />INSPECTION <br />Sewer District <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Approved By ' L- t <br />xn <br />City Engineer <br />Issued By _ <br />Connection By <br />Inspection By K- Cn//a AA J <br />Date I nspected 3'1117% <br />