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City of Everett <br />Engineering Departinent Ir, <br />Sewer Application and Permit' <br />No. 21165 DATE <br />Service Address__ <br />Utility Account No. --- <br />Billing Address —_ <br />Connectic Permit Fee_ <br />City, State, Zip <br />Connection Fee --- <br />Owner (Mortgagor) <br />Total Fee <br />Billing Name__ <br />Connection By <br />Address I'' .7 f <br />Signed <br />Customer <br />Phone �Z <br />DESCRIPTION: <br />Sewer District —= - <br />Lot t ' 6 <br />Monthly Sewer Service <br />Block__— LOeliE:i <br />Division or Addition <br />Monthly Sewer Constr. <br />Trunk <br />— <br />Type Permit: <br />Lateral <br />Remarks: <br />a <br />SEE SKETCH ATTACHED <br />INSPECTION <br />Abutting Lot Line <br />N, S, E, W, <br />Approved <br />ngmecr <br />Issued <br />Inspection By <br />Date Inspected <br />No. 21165 <br />✓ 'w <br />