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everett <br />City of Everett <br />Engineering Department <br />Sewer Application and Permit <br />NO. DA i E <br />Service Address Utility Account <br />Billing Address Connection Permit <br />City, State, Zip Connection Fee_ <br />Owner (Mortgagor) Total Fee <br />Billing Name <br />Connection B <br />DESCRIPTION: <br />Lot <br />Block <br />Division or Addition <br />Type Permit: <br />SEE SKETCH ATTACHED <br />Signed <br />customer <br />Sewer D <br />Monthly Sewer Service Z S 0 <br />Monthly Sewer Constr. <br />Trunk <br />Lateral -2, z i <br />Abutting Lot Line <br />N, S, E, W <br />Approved By <br />City Engineer <br />Issued <br />Inspection By 42, le +�y <br />)ate Inspected_ //-9zht <br />No. 21513 <br />