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U <br />eeverett <br />City of Everett <br />Engineering Department <br />pyak -7 <br />o 5 <br />Sewer Application and Permit <br />NO. 2 p r % i DATE `` F, y <br />Service Address !. � -I— —> / _ Utility Account N <br />U <br />Connection Permit Fee -,? <br />Billing Address — <br />City, State, Zip F `!• i V"1 — <br />i' <br />Owner (Mortgagor) i• �' <br />Billing Na <br />Connection By_ e�,Cif <br />i <br />Address , 7.7?1 <br />Phone � < '2 — 2 7 7 / <br />DESCRIPTION <br />Lot <br />Block <br />Division or Addition ���ty1 f t�l,f_t 5 r/^ )"q <br />a <br />SEE SKETCH ATTACHED <br />Connection <br />Total F <br />Signed <br />Customer <br />Sewer <br />Mcnthly Sewer S <br />Monthly Sewer Constr <br />Approved By. <br />City Enyincer <br />Issued <br />Connection B <br />Inspection By� �T<i <br />Date I nspectcd <br />