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Ll <br /> everett V . 1-- ._ 2 <br /> City of Everett 32379 <br /> Engineering Department <br /> Sewer Application and Permit <br /> NO.Z0052 DATE __ — <br /> Service Address a0 - 7 Sr -_ Utility Account No. <br /> Billing Address Connection Permit Fee <br /> City,State, Zip Connection Fee <br /> Owner (Mortgagor) Total Fee- <br /> BillinD Name <br /> Connection By '_L <br /> Signed <br /> Address Custorner <br /> Phone <br /> DESCRIPTION: <br /> Lot i <br /> Block <br /> Division or Addition <br /> Sewer District <br /> —� Monthly Sewer Service <br /> Remarks: - <br /> --- Monthly Sewer Constr. <br /> Ll <br /> Approved By_ <br /> City Engineer <br /> Issued By <br /> Connection By - <br /> Inspection By <br /> Date Inspected /2 s l7 Z-- <br /> SEE <br /> SEE SKETCH ATTACHED INSPECTION <br />