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evere)t <br />City of Everett <br />Engineering Department <br />Sewer Application and Permit <br />No. 21198 DATE <br />Service Address_ <br />Billing Address <br />City, State, Zip --- <br />Owner (Mortgagor) <br />Billing Name <br />Connection By <br />DESCRIPTION: <br />Lot <br />Block <br />Division or Add <br />nemarKs: <br />SEE SKETCH ATTACHED <br />INSPECTION <br />Utility Account No <br />Connection Permit <br />Connection Fee_ <br />Total Fee <br />S <br />Sewer District <br />Monthly Sewer Service. <br />Monthly Sewer Constr. <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. 21198 <br />