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everep � <br />City of Everett <br />Engineering Department <br />Sewer Application and Permit <br />N0.'4U437 DATE <br />.::�- j-17 - 1 /e> ' Do <br />Service Address _ Utility Account No. <br />Billing Address Connection Permit Fee - <br />City, State, Zip.' -A " i Connection Fee 'w A-C K Q 11 A�' S •y <br />Owner (Mortgagor) t - u; nAf Total Foe ��G <br />�— <br />Billing Name R • L . `> WMT-z 1C A <br />Connection BY. <br />Address_ / ✓ /� V Signed ' <br />Cwtorner <br />Phone -- <br />DESCRIPTION: <br />Lot A%G <br />Block - <br />Division or Addition -- :' �- 1 V - <br />Remarks: _.� ;,,f�;.-r.,,) <br />f/ <br />r <br />SEE SKETCH ATTACHED <br />INSPEC1ION <br />Sewer District_ <br />Monthly Sewer Service_ e <br />Monthly Sewer Constr <br />I'; I A : II/, <br />Approved By - " I r "Z <br />CAV Engineer <br />Issued By -f r - . <br />Connection By _ <br />Inspection By �t i <br />)ate Inspected/9,/ 7 3 <br />