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everett <br />City of Everett <br />Engineering Department <br />Sewer Application and Permit <br />NO.'10 4 3 6 DATE �--- r _ %__, <br />Service Address — <br />Billing Address �^ Vn n rir?c. <br />City, State, Zip t r- TT Ii <br />Owner (Mortgagor) z 1 / " n"'/6 G�X' <br />Utility Account No. <br />Connection Permit Fee` - <br />Connection Fee_ - + 7 <br />Total Fee <br />Billing Name �� A 1 f' <br />Connection By,'� �,/t � <br />Address r ° `��<� r / Signed cuuumer <br />Phone "'2hl/FNS <br />DESCRIPTION: <br />Lot -2 " <br />Block - ' <br />Division or Additions �'' "1 r k `_ 4— / _ S <br />Sewer District <br />�.•,, Sri <br />hl S er Service r <br />Remarks: ) :. L1 "' <br />M <br />M <br />Ap <br />� <br />I ss <br />Co <br />—_ <br />---- " <br />In! <br />Da <br />M, <br />SEE SKETCH ATTACHED <br />I%I51'f�'11,i[ <br />ont y ew _ <br />onthly Sewer Constr. <br />proved By •' %1' =_ ' L/. t ) D <br />Coy Engmeer <br />ied <br />nnection By-- <br />pection By _Ti `t <br />.e I nspected 11 73 <br />�7L rl�— <br />V <br />