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everett <br />61 <br />City of Everett ti <br />Engineering Department to <br />Sewer Application and Permit <br />5 ° r- <br />NO. 21054 ' \, DATE <br />Service Address Utility Account No, <br />Billing Address <br />Connection Permit <br />City, State, Zip f'!/f &. --Z, Connection <br />Owner (Mortgagor) Total Fee <br />— <br />Billing !�� r�(l1/ <br />Billing Name <br />Connection By fir' /,✓/I/ <br />r / ? <br />Address Signed_ <br />Phone J.1YG/ <br />DESCRIPTION: Sewer District <br />Lot <br />Block ' Monthly Sewer Service <br />Division or Addition i%�l/ ^ i %i.;_". Monthly Sewer Constr. <br />Type Permit: Trunk <br />Remarks: �i✓v „p s /Ts GrE6d C°o <F-FD <br />/it(T iV0 /ySfJ�rTi/// M/!DE <br />SEE SKETCH ATTACHED <br />INSPECTION <br />Abutting Lot Line <br />N, S, E, W. <br />Approved By <br />City Engineer <br />Issued <br />Inspection <br />)ate Inspected <br />NO- 21OJ'1 <br />