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evereri <br />e��-2�z,-s� <br />City of Everett <br />Engineering Department <br />�l� <br />� .�����//��75�P� <br />c� <br />Sewer Application and Permit <br />rvo. 2 0 819 DATE ��-; r, <br />Service Address �•' � -� -t- " Utility Account No. <br />Billing Address — Connection Permit Fee •' <br />r <br />�. <br />City, State, Zip �:-" " Connection Fee_ <br />Owner (Mortgagor) " �` � Total Fee <br />Bi!iing Name ` � -' ' � <br />Connection By <br />Address �" - • -'-" � ' � •` Signed <br />cuuome. <br />� Phone <br />DESCRIPTION: Sewer District <br />Lot ' <br />Block 353 Monthly Sewer Service <br />Division or Addition —5�" �i�c.�.r� .�/nD Monthly Sewer Constr. <br />SEE SKETCH ATTACHED <br />•� misr-�rcnor� <br />a <br />�ateral <br />Abutting Lot Line <br />N, S, E, W ft. <br />Approved By <br />City Engineer <br />I SSUE(� <br />Inspection By ���as � /� <br />Date l nspected �� �y �� <br />N0. LO��.� <br />