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N <br />City of Everett <br />Engineering Department <br />Sewer Application and Permit <br />No. 21696 DATE <br />Service Address1aOJ—�C <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Name <br />30-zcl- S <br />Utility Account No. _ <br />Connection Permit Fee <br />Connection Fee <br />Total Fe:__ <br />Connection By t 4 <br />Address_ Signed 44.,1 <br />Customer ' <br />Phone <br />DESCRIPTION: Sewer District_ <br />Lot /(p --/ 2 <br />Block, Monthly Sewer Service <br />Division or AdditionZ� I,A�7LX� _ Monthly Sewer Constr. <br />SKETCH ATTACHED <br />INSPECTION <br />Trunk <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. 21696 <br />