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everett <br />e <br />City of Everett <br />Engineering Depart nent <br />Sewer Application and Permit <br />NO. 21275 DATE <br />Service Address_ <br />Billing Address_ <br />City, State, Zip_ <br />Owner (Mortgagor) <br />Billing Name_ <br />Connection By — <br />Utility Account No., <br />Connection Permit F <br />Connection F <br />Total Fee_ <br />Address _ Signed <br />Customer <br />Phone <br />DESCRIPTION: Sewer District_ ___ <br />Lot <br />Block Monthly Sewer Service _ <br />Division or Addition_ — Monthly Sewer Constr. <br />— — Type Permit: Trunk_ <br />/ Lateral <br />Remarks: <br />— -- Abutting Lot <br />ne <br />N, S, [, W_ ft. <br />_1 <br />-- --+Approved By - <br />City Engineer <br />`' !KETCH ATTACHED <br />INSPECTION <br />Issued By. <br />Inspection By__ "7�?f <br />Date Inspected_ — As — <br />No. 21275 <br />