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everett ��i4. <br />e <br />.10 <br />City of Everett <br />Engineering Department <br />Sewer Application and Permit <br />No. 212331 DATE <br />i <br />Service Address <br />Billing Address <br />City, State, Zip <br />'z eS " <br />f � 1 <br />Cf' , <br />z.o -t.q . <br />p <br />Utility Account No <br />Connection Permit Fee _ <br />Connection <br />Owner (Mortgagor) / .11 1 Total <br />Billing Name <br />Connection Byi ✓�+'� <br />Address �'/; i : i-- s <br />Phone '•�//n r <br />Signed <br />Customer <br />DESCRIPTION: Sewer District <br />Lot <br />Block Monthly Sewer Service <br />Division or Addition % Monthly Sewer Constr. <br />SEE SKETCH ATTACHED <br />INSPECTION <br />Tru <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. 21238 <br />