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W <br /> City of Everett <br /> Engineering Department <br /> Sewer Application and Permit <br /> NO. 10299 DATE <br /> z�v - 76 Z-L- -1 w <br /> I — Utility Account No. <br /> Service Address s <br /> Billing Address <br /> /f /L Connection Permit Fee r <br /> � <br /> City, State, Zip—. Connection Fee 1 <br /> Owner (Mortgagor) !'�A?~ _T L OV L- Total Fee <br /> Billing Name �' "�f 4 <br /> Connection By <br /> Address_ Signed <br /> Custamnr <br /> Phone `� �' ' it <br /> DESCRIPTION: <br /> Lot Block-- <br /> Division <br /> lock Division or Addition.— " ✓ / '�t' s <br /> Sewer District— <br /> V. <br /> istrictV — <br /> ____ Monthly Sewer Service <br /> Remarks: ✓�l" ._ �F r Tlf'"� Monthly Sewer Constr. <br /> r, <br /> , <br /> kY. Approved <br /> Engineer <br /> ' f (/,ILS• r _ n V�_. <br /> /i. Issued By — <br /> Connection By <br /> { � Inspection <br /> Date I nspected_ <br /> �•'S� .�:�.,t-cep z Su,� F� <br /> m <br /> SEE SKETCH ATTACHED INSPECTION <br />