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"eye. ett, <br />IQ <br />t, S� <br />City of Everett <br />Engineering Department <br />3c1:3-Z�j-s— <br />(: W <br />Sewer ,Application and Permit <br />No. 21339 DATE <br />Service Address <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Name <br />Connection By <br />DESCRIPTION: <br />Lot <br />Block <br />Division or Addition <br />SEE SKETCH ATTACHED <br />IN OIFECIIUN <br />Utility Account No._ <br />Connection Permit Fee_ <br />Connection Fee <br />Total Fee <br />Signed <br />Customer <br />Sewer District <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Lateral <br />Abutting Lot Line <br />N, S, E, W. <br />Approved By <br />Cuy Engineer <br />Issued <br />nspection By l'_ <br />)ate Inspected <br />No. 21339 <br />