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evereri <br />e <br />City of Everett <br />Engineering Department <br />Sewer Application and Permit <br />N0. L i�J O n DATE ,�;� <br />Service Address Utility Account Nc <br />Billing Address Connection Permit <br />City, State, Zip Connection Fee_ <br />Owner (Mortgagor) Total Fee <br />9illing Name <br />Connection By -- <br />DESCRIPTION: <br />Lot <br />Block <br />Division or A,ddition <br />Tvoe Permit: <br />Signed ' � �� <br />Customer <br />Sewer District <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />SEE SKETCH ATTACHED <br />�er�,-r i IOPI <br />Lateral <br />tting Lot Line <br />N, S, E, W. <br />�oved BY <br />Ciry Engineer � <br />ection By ' _, " <br />Inspected ' — <br />No. 2150G <br />