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61 <br />City of Everett <br />Engineering Department <br />Sewer Application and Permit <br />NO.Z.0450 DATE <br />Service Address <br />Billing <br />City, State, Zip % <br />Owner (Mortgagor) t �� — 1_"' w <br />Utility Account No. <br />Connection Permit Fee; <br />Connection <br />Total Fee <br />Billing Name <br />i t ff l t�[+� L t /�.L <br />Connection By r <br />n7 j� I�` �• �'. ,rl/!=[ Signed <br />Address c1,110"t <br />Phone 'S <br />DESCRIPTION: <br />Lot <br />Block <br />Division or Addition_; t t�A ' �! 714 <br />Sewer District <br />_ <br />Remarks: r <br />I.I, <br />MI <br />50r I71Ffa 2 5r <br />Al <br />G � <br />Ise <br />Cc <br />In <br />De <br />n <br />SEE SKETCH ATTACHED I'iti"rt l r' <br />inthly Sewer Service <br />tnthly Sewer Constr. <br />proved By Gry Engineer <br />ued By <br />innection By_ <br />spection By 'ID <br />to Inspected el Z/.zi/7 3 <br />