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evergn � <br />� <br />City of Everett <br />Engineering Uepartment <br />5ewer App";;cation and Perruiit <br />rvo.2 '� � i ��i'� <br />Scrvice Address___ __ <br />B;Iling Address <br />city, state, zip <br />Owner (Mortgagor�_ <br />E3illing Name <br />Connection By __ <br />Address <br />Phonc_ <br />DESCRIPTION <br />Lot <br />Block <br />Division or AddiUon <br />_ _--------- <br />Rcinarks: <br />DATE <br />, <br />li.a..u.1—�_f� �wt � �� <br />�� " e <br />�;'�—_ _ — _�� � �� �Ltit.� • <br /><�,< .Lwzi.�.d 1:� .i%�. � t <br />v <br />SFESKETCH ATTACHED <br />Utility Account No., <br />! �nnection Permit F <br />Connection Fee_ <br />1-otal Fee <br />Siyne��— <br />� - � — � — - �-�:.-i ;.�,-, - <br />___ Stwui L)isUict_ <br />�Munthly Sewer Servia <br />111onthly Sewer Constr <br />/f2o-7 <br />!\pprove„ By <br />a�v e��u�„�•�•, <br />I;sued P.y_ _ <br />Connection By _____ _ <br />Inspection By�d?C..lCco�sa <br />Date Inspected_ l�Q 4 '13 <br />