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a <br />eD <br />City of Everett <br />Engineering Department <br />21-Zt- 5-' �,� <br />Sewer Application and Permit <br />NO. 20864 DATE / — eK— 7 `- <br />Service Address " /_ ' O'. <br />Utility Account No. <br />Billing Address Connection Permit Fee <br />City, State, Zip s'' % % Connection Fee <br />Owner (Mortgagor) i / Cl /;�i r Total Fee <br />Billing Name <br />Connection By -•YT /tri,UL�t +G.�%'fIi/...�,�`�: <br />Address / i -/ir✓ Signed— <br />Phone — <br />DESCRIPTION: Sewer District <br />Lot <br />Block <br />Monthly Sewer Service. <br />Division or Addition 7f1/i/n A/7 z 11- i; Monthly Sewer Constr. <br />SEE SKETCH ATTACHED <br />INSPECTION <br />Abutting Lot Line <br />N, S, E, W <br />Approved By_._ <br />City Engineer <br />Issued <br />Inspection By:;?/� /�O-' <br />Date Inspected e-n! <br />No. 20864 <br />