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everett <br />.� <br />City of Everett <br />Engineering Depr,rtment <br />Sewer Applicotion and Permit <br />NO. 21 � 2 � DATE � <br />� <br />Service Address � <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Name <br />Connection Bv_ _ _ <br />�nn�-L � � <br />DESCRIPTION: <br />Lot <br />Block � � <br />Division or Addition. <br />.. � !_.L� r. �— ��J ', �� " '. � <br />, <br />�. Q ��� /D �G �� . <br />J- - � 'r ! k� � .� . �'. <br />__. � � — -� _� <br />�J G S % � Q � <br />C - zo _zq- S— � <br />Z-Z7— �� <br />�3�,a. i�o <br />� <br />Utility Account No.. <br />Connection Permit F <br />Connection Fee_ <br />Total Fee <br />Signed <br />CUStOR1Ef <br />SEE SKETCH ATTACHED <br />,. _;���r�,,�.���: <br />Sewer District <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />Approved By <br />City Enyineer <br />ISSUCd <br />Inspection <br />Datelnspe <br />No. �1_226 <br />