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evereft <br />e�j-... <br />City of Everett <br />Engineering Depertment <br />_ j ." _. <br />� ���� ��� <br />/ --- 'Z ,�' -- `.. <br />f <br />Sewer Application and Permit � <br />N0. 21 �� 5 DATE f; , I t\ <br />� I <br />Service Address i � ` <br />Billing Address_ � <br />City, State, Zip <br />Owner (Mortgagor) ' ' <br />Billing Name <br />Connection Bv—__ _ - <br />� ���; I, �� Gc �•�� <br />.ij, - � , <br />i-� �f/. D��� l�1� f{, iN c �..,�, <br />,,�, -: ,.� Re{�a�� — � <br />` f', ,-Tc ti c-.5'(iG - . �l <br />Utility Account No. <br />Connection Permit Fee <br />Connection Fee <br />Total Fee <br />Haaress Signed <br />Customer <br />Phone ,(t�^' . <br />ta <br />DESCRIPTION: Sewer District <br />Lot <br />Block Monihly Sewer Service <br />Division or Addition Monthly Sewer Constr. <br />Tvae Permit: Trunk <br />Lateral <br />SEESKETCH ATTACHED <br />�����f'I ��� �iiAl <br />Abutting Lot Line <br />N, S, E, W. <br />Approved By <br />City Engineer <br />Issued <br />Inspection <br />Datelnspe <br />� � � ; ; <br />...il ii� . . <br />;� ;c. <br />rvo. ?1195 <br />