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evercu <br />City of Everett <br />Engineering Department <br />Sever Application and Permit <br />NO .1041J DAII <br />23098 <br />Service Address Utility Account No. _- <br />Billing Address Connection Permit Fee <br />City, State, Zip_ Connection Fee <br />Owner )Mortgagor) Total Fee <br />Billing Name <br />Connection By — <br />Address Signed- <br />C...romer <br />Phone — <br />DESCRIPTION: <br />Lot — <br />Block_ —__ <br />Division or Addition----- _ <br />Se D't't <br />Remarks: <br />W <br />SEE SKETCH ATTACHED <br />aw r is r c <br />Monthly Sewer Service_,___ <br />Monthly Sewer Constr. _ <br />Approved By <br />c.1 V <br />Issued By <br />Connection By --- <br />Inspection By y � <br />Date Inspected /' 7 3 <br />