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W <br />City of Everett <br />Engineering Department <br />Sewer Application and Permit <br />NO. <br />Service Address_ <br />Billing Aadress_ <br />City, State, Zip_ <br />Owner (Mortgagor) <br />Billing Name_ <br />Connection By_ <br />Address <br />DESCRIPTION: <br />Lot <br />Block_ <br />Division or Addition <br />Type Permit: <br />rV7_-Uq <br />Remarks: <br />—S. <br />a <br />SEE SKETCH ATTACHED <br />Utility Account No.. <br />Connection Permit F <br />Connection Fee_ <br />Total Fee <br />�.. <br />Sewer District <br />Monthly Sewer Service <br />Monthly Sewe" Constr. <br />Trunk <br />Abutting Lot Line <br />N, S, E, W. <br />Approved By <br />City Engineer <br />Issued <br />Inspection By — <br />Date Inspected .'it -? - <br />No. 21494 <br />