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everen <br />e <br />City of Everett <br />En�ineeriny Dep�rtment <br />Sewer Application and Permit <br />r,o. 216 5 3 DATE <br />Service Address 2. q`1.�7 l-{ E u� ��-rr - <br />Billing Address <br />City, State, Zip a �, <br />Owner (Mortgagor► � i � . � . l. . ' <br />Billing <br />Ccn�ection By i� �— <br />Address <br />DESCRIPTION: <br />Lot �=�_ <br />Block (,QS{`af <br />Division or Addition <br />Type Permit: <br />Remarks: <br />Utility Account Nc <br />Connection Permit <br />Connection Fee_ <br />Total Fee <br />Signed� _....�- . � , <br />cusims.• --. E <br />Sewer District <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Tru <br />Abutting Lot Line <br />N, S, E, W. <br />SEE SKETCH ATTACHED <br />irvsNEcrc>n <br />�roved By ' ; <br />city e�ylneer <br />ed By <br />ection By ' _ , <br />Inspected-;-� - <br />> . , <br />No. ^c1653 <br />