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eW <br />City of Everett <br />Engineering Department <br />Sewer Application and Permit <br />No. 21218 DATE %/ ` , >r L <br />Service Address Utility Account N( <br />Billing Address Connection Permit <br />City State, Zip_ Connection Fee <br />Owner (Mortgagor) Total Fee <br />Billing Name <br />Connection By <br />Phone <br />DESCRIPTION: <br />Lot <br />Block <br />Division or Addition <br />type Permit: <br />SEE SKETCH ATTACHED <br />INSPECTION <br />Signed <br />Sewer District <br />Monthly Sewer Service <br />Monthly Sewer Co'nstr. <br />Trunk <br />Abutting Lot Line <br />N, S, E, W <br />Approved By <br />City Engineer <br />Issued B <br />nspection By — <br />) <br />ate Inspected_ <br />No. 21218 <br />I <br />