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everett <br />e <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Permit <br />NO. 21796 DATE CG 'Z� I I "1 <br />Service Address <br />Billing Address <br />vC c7Z�� <br />City, State, Zip <br />Owner (Mortgagor) J— <br />Billing Name <br />Connection By <br />Address <br />DESCRIPTION: <br />Lot Block <br />Utility Account No. <br />Permit F <br />Connection Charge(s)� <br />Total Fee_ IL <br />�L c�c_ "rt� <br />Signed_ Customer <br />Sewer D <br />Monthly Sewer <br />Plat _ w� Monthly Sewer Constr. <br />Unplatted Description <br />Trunk _ <br />Lateral <br />lbutting Lot Line <br />N, S, E, w <br />Approved By <br />City Engmee� <br />issued B. <br />Inspection Bye — <br />Date Inspected G 7 7 <br />NO. <br />SEE SKETCH ATTACHED INSPECTION <br />