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D <br />City of Everett <br />Engineering Department <br />c t�� <br />Sewer Application and Permit <br />NO. 21072 DATE 7 <br />3% <br />Service Addrez= Utility Account <br />Billing Address <br />City, State, Zip 1 f ! <br />Owner (Mortgagor) <br />Billing Name <br />Connection By <br />U � <br />Address <br />Phone — <br />DESCRIPTION: <br />Lot <br />Connection Permit Fee AL0, J ; -' <br />Connection <br />Total <br />Signed .(} IA,— <br />Customer <br />Sewer Dist <br />Block Monthly Sewer Service <br />Division or Addition /7776 a /� F Monthly Sewer Constr. <br />Type Permit: <br />r ") <br />Remarks: v-1z <br />1 r- i:'•, t <br />. "I <br />A/a /VSp�c7/e y <br />e <br />SEE SKETCH ATTACHED <br />INSPECTION <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />Approved By <br />City Engineer <br />Issued By <br />Inspection By <br />Date I <br />NO. 21072 <br />