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everett <br />City of Everett <br />Engineering Department <br />Sewer Application and Permit <br />NO. 1645 DATE r /i q I I <br />Service Address CPS <br />c <br />Billing Address <br />City, State, Zip 1__ T T <br />Owner (Mortgagor) ___Z �✓' d �(-iL�',r�v <br />Billing Name_. <br />Connection By <br />PF <br />Utility Account Nc <br />Connection Permit <br />Connection Fee_ <br />Tot,:l Fee <br />Signed <br />Customer <br />DESCRIPTION: Sewer District <br />Lot _1 :7—La— Monthly Sewer Service. <br />Block ? hLr <br />Division or Addition r! ,— n Monthly Sewer Constr. <br />Type Permit:`YJJ_jl— ——� <br />Remarks: <br />Trunk <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />Approved <br />Issued <br />Inspection <br />Engineer <br />Date Inspected_ — <br />SEE SKETCH ATTACHED No. 2164b <br />