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ever`eri <br />e <br />.10 <br />City of Everett <br />Engineering Department <br />Sewer Application and Permit <br />No. 21650 DATE <br />Service Address5? <br />Billing Address <br />Utility Account No <br />Connection Permit <br />City, State, Zip Connection <br />Owner (Mortgagor) Total Fee_ <br />Billing <br />Connection <br />Address_ _ Signed <br />Customer <br />Phone_ <br />DESCRIPTION: Sewer District <br />Lot <br />Block <br />Monthly Sewer Service <br />Division or Addition Monthly Sewer Constr <br />Type Permit: Trunk <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />Approved By <br />City Engineer <br />Issued <br />Inspection By_ <br />Date Inspected <br />NO. ".�. J : O <br />