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everett <br />e <br />City of Everett <br />Enpnaerinp Dep�rtment <br />Sewer Application and Permit <br />No. 21 2 8 6 DATE � <br />Service Address <br />Billing Addrass <br />City, State, Zip <br />Owner �Mortgagor) - � <br />Billing Name - � <br />Connection By r - <br />DESCRIPTION: <br />Lot - <br />Block � <br />Division or Addition. <br />Type Permit: <br />Utility Account Nc <br />Connection Permit <br />Connection Fee_ <br />Total Fee <br />` � M �f � �-,� <br />�._ .� <br />�-_�a._��,..�- <br />�` �. � � <br />� _.y 4if/' �` ' / <br />Signed <br />customer� <br />a <br />SEE SKETCH ATTACHED <br />INSPECTION <br />Sewer District <br />Monthly Sewer Service <br />Montlily Sewer Constr. <br />Trunk <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />Approved By <br />Ciry Enpineer <br />ISSUOd BY_ <br />Inspection By �- '�/10 : 5 �-j � <br />Date Inspected 3— z G— i� <br />No. 2128� <br />r <br />