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Ej <br />it� <br />i <br />City of Everett <br />Engineering Department <br />Sewer Application and Permit <br />NO.;.10435 <br />DATE <br />Service Address <br />Billing Address ti <br />City, State, Zip_ <br />Owner (Mortgagor)_ + /'= c / j /,•, rir , <br />Billing Name_ <br />Connection By f-- L L1j/t I� rQ <br />Address to f"��—>X _�r� e// <br />Phones,Ahce iL'�rEnJ S _t: r <br />Utility Account No. _ — 41 <br />Connection Permit Fee <br />Connection Fee <br />Total Fee <br />Signed <br />customer <br />DESCRIPTION: <br />Lot -L I; - <br />Block -- <br />Division or Addition L !/ f oe 'n,() <br />Sewer District <br />Remarks: r� _ Monthly Sewer Service c- <br />c <br />Monthly Sewer Constr.,_ <br />EJ <br />Approved By " .1�•. i,rJ: / J <br />&�ir.%- C•(%/"X _� r�a0 City Enpmexr <br />"�QG IF ib' / Issued By <br />SEE SKETCH ATTACHED <br />Connection By, ,.,.�L� <br />Inspection By •0n r?4- <br />Date Inspected_ / 21j 73 <br />n <br />n <br />