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everett <br />e <br />City of Everett <br />Engineering Department <br />Sewer Appliccrdon and Permit <br />No. 21596 DATE <br />Service Address <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Name <br />Connectirit <br />Phone - C/ <br />20 S �E C� <br />Utility Account No.- <br />Connection Permit F <br />Connection Fee_ <br />Total <br />1 / - <br />Signed <br />DESCRIPTION: Sewer District <br />Lot Monthly Sewer Service. <br />Block <br />Division or Addition _ <br />2. y 77 /,i: �_ Monthly Sewer Constr. <br />0 <br />SEE SKETCH ATTACHED <br />INSPECTION <br />Tru <br />Ab:itting Lot Line <br />N, S, E, W <br />Approved By <br />City Engineer <br />Issued <br />r <br />Inspection By � "`Z <br />Date Inspected : 9z? <br />No. 21596 <br />