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tveren <br />e <br />City of Everett <br />Enpineering Department <br />Sewer Application and Permit <br />No. 212 7 b DATE �� i <br />Service Address <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Name <br />Connectiun By <br />Adciress <br />DESCRIPTION: <br />Lot � <br />Block <br />Division or Addition <br />Type Permit: <br />Utility Account No. <br />Connection Permit I <br />Connection Fee_ <br />Total Fee_ <br />,�� : y �= �`�� <br />� --,8- �. y _b�' <br />� .�-- �.r <br />f,��'�% /L <br />Signed - - -- - <br />Cusiomer <br />SEE SKETCH ATTACHED <br />r�isrrcriori <br />Sewer District <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Abutting Lot Line <br />N, S, E, W. <br />Approved By <br />Ciry Enyineer <br />ISSUE� <br />Inspection By <br />Date Inspected • � <br />No. 21.?_76 <br />