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everett <br />t <br />City of Everett <br />Engineering Department <br />Severer Application and Permit <br />No. 214 4 6 DATE <br />Service Address <br />Utility Account No. <br />Billing Address '7 *7 <br />7 r / Connection Permit Fee_ <br />City, State, Zip, <br />Connection Fee <br />Owner (Mortgagor) <br />Total Fee <br />Billing Name <br />� , r <br />Connection By <br />Address <br />Signed / / f/ ! If <br />Customer ! 0 1 <br />Phone <br />DESC160TION: <br />Sewer District— <br />Lot — <br />Block <br />Monthly Sewer Service <br />Division or Addition <br />Monthly Sewer Constr. <br />Type Permit: <br />Trunk <br />SEE SKETCH ATTACHED <br />INSPECTION <br />r <br />Abutting Lot Line <br />N, S, E, VJ ft. <br />Approved By <br />City Engineer -/ <br />Issued <br />Inspection By ^/�u�� <br />Date inspected / e ,./ 7 <br />NO. 21446 <br />