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W <br />City of Everett <br />Engineering Department <br />Sewer Application and Permit <br />NO. DATE <br />I <br />Service Address�/r5Y49 (wed' <br />Utility Account No <br />Billing Address_ <br />Connection Permit <br />City, State, Zip <br />Connection Fee_ <br />Owner (Mortgagor)_ <br />Total Fee__ <br />Billing Name <br />Connection By -- <br />Address <br />Signed <br />DESCRIPTION: <br />Lot _j / J.r / Z — <br />Dlock_—,3 / 1-- <br />Division or Addition <br />Tuna PermU: n <br />i <br />Remarks: <br />�2p �f <br />A 20 -2 4 -s <br />9-A A <br />Sewer District <br />Monthly Sewer Service. <br />Monthly Sewer Constr. <br />Ahutting Lot Line <br />N, S, E, W <br />Apprroed <br />Issued <br />Inspection <br />Date InsDe <br />Engineer <br />s SEE SKETCH ATTACHED NO. 21673 <br />