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L <br />l <br />City of Everett ' <br />Engineering Department <br />Sewer Application and Permit <br />NO.40283 <br />DATE <br />32837 <br />Service Address I L'• Utility Account No., <br />Billing Address r.' ft t' Kt `!' Connection Permit Fee_ — <br />City, State, Zip - 7 7 ! J17, 1 Connection Fee -' <br />Owner (Mortgagor) Total Fee. ---'— <br />Billing Name <br />Connection By - <br />Address r— f7 4r Signed �. <br />Cusrnm r <br />DESCRIPTION: <br />Lot =' <br />Block <br />Division or Addition ti'�f <br />Sewer District <br />r <br />Monthly Sewer Service r <br />Remarks: <br />Monthly Sewer Constr. <br />'V "(w4r ovl 7.-/ r�G,..%'a-,14 g ifX y rJA-Q- D <br />S P sS <br />SEE SKETCH ATTACHED <br />iNSPLCTION <br />F <br />Approved By J%ram L f l r1i V <br />CIIV npineer <br />r <br />Issued By <br />Connection By <br />Inspection <br />Date Inspected y 7.3 <br />