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everett <br />Pi <br />City of Everett <br />Engineering Department <br />Sewer Application and Permit <br />NO. <br />lL•rr: <br />Service Address_ ' z 90_L -1 121"i C_ <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Name <br />Connection By <br />U - ✓z - zq- s� <br />Utility Account No. <br />Connection Permit Fee <br />Connection Fec <br />Total Fee_ <br />ruw ess __ <br />Slgned <br />Customer <br />Phone <br />DESCRIPTION: <br />Sewer District <br />Lot —2 <br />-- <br />Block _`L� <br />Monthly Sewer Service <br />Division or Addition <br />Monthly Sewer Constr, <br />Type Permit: <br />Trunk <br />o.. ati G(i��(a� <br />Lateral <br />Remarks: <br />Abutting Lot Line <br />— -- <br />— N, S, E, W <br />a <br />SEE SKETCH ATTACHED <br />Approved By <br />City Eng'nee, <br />Issued <br />Inspection By — <br />Date Inspected__ <br />No. 21655 <br />