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evereft <br />eNAY- %ems fF� <br />City of Everett 3 3- <br />Engineering Department <br />q1as/�7 <br />Sewer Application and Permit <br />No. 21641 DATE <br />Service A.ddress.4 -7 Z <br />� j-Q4 / <br />Utility Account No. <br />Billing Address <br />Connection Permit Fee <br />City, State, Zip __r -,- <br />_ Connection Fee <br />Owner (Mortgagor) <br />Total Fee <br />Billing Name <br />Connection By - <br />-- - Signed n� <br />ustomer <br />Phone C- <br />DESCRIPTION: Sewer District <br />Lot �j2-'2 <br />Block_ Monthly Sewer Service <br />Division or Addition ,�/?ii� 14 Monthly Sewer Constr. <br />Trunk <br />Lateral <br />Abutting Lot Line <br />N, S, E, w <br />Approved By <br />City Engineer <br />ssued <br />nspection <br />late Insoe <br />SGE SKETCH ATTACHED <br />INSPECTION <br />No. 21641 <br />