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everett <br />e <br />City of Everett <br />Enpineering Department <br />Sewer qpplicction and Permit <br />No. 2135�� DATE <br />Service Address <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Name ' ` ' <br />Connection By ' <br />�G ,, �c.�'� <br />� -- � � �,. �. � _ .; <br />,�"� � <br />Utility Account No. <br />Cannection Permit Fee " � ` <br />Connection Fee <br />Total Fee � <br />Signed � � — <br />Customer <br />DESCRI�TION: Sewer District <br />! uc Monthly Sewer Servic� <br />Block `� <br />Givision or Addition - ' Monthly Sewer Constr. <br />SEE SKETCH ATTACHED <br />Abutting Lot Line <br />N, S, E, W <br />Approved By ' <br />City Enpineer <br />Issued By ' <br />Inspection By � ��ott y' � % <br />Date Inspected�_� — � � <br />No. ?1355 <br />