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everett <br />e <br />City of Everett <br />Engineering Department <br />Sewer Application and Permit <br />No. 21380 DATE <br />Service Address <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Name <br />Connection By <br />Address <br />Utility Account No.. <br />Connection Permit F <br />Connection Fee_ <br />Total Fee <br />;t y <br />Signed — <br />--customer <br />--Customer <br />Phone F u `— <br />DESCRIPTION: Sewer District <br />Lot c.. <br />Monthly Sewer Service <br />Block <br />Division or Addition Monthly Sewer Constr. <br />Trunk <br />Tvoe Permit: <br />SEE SKETCH ATTACHED <br />INSPECTION <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />Approved <br />Issued <br />City Engineer <br />Inspection By., — <br />Date Inspected <br />No. 21380 <br />i <br />