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11 <br />City of Everett <br />Engineering Department <br />Sewer Application and Permit <br />NO. J.u380 I).\iI <br />Service <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Name_ <br />Connection By__ • _' - _ • _- _ <br />Address_ _ <br />Phone <br />Utility Account No. • { <br />Connection Permit Fee ` <br />Connection Fee ! ' • ? <br />Total <br />Signed ` <br />CUftonRr <br />DESCRIPTION: <br />Lot <br />Block <br />I Division or Addition__ <br />< r <br />Sewer District_ .1 = <br />Remarks:' <br />Cr %tom f &Zt4�e� �! e l d' YJ7 <br />W <br />SEE SKETCH ATTACHED <br />INSPECTION <br />Monthly Sewer Service <br />Monthly Sewer Constr.— <br />Approved By f /�c� L Ul_) <br />City Engineer <br />Issued By <br />Connection By <br />Inspection By AO- 6 �/e '«^� <br />)ate Inspected <br />