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everett <br />�e <br />City of Everett <br />Engineering Department ��1 <br />Sewer Application and PermR�r <br />N�� 2103� <br />Service Address__ <br />Billing Address <br />City, State, 2ip <br />Owner (Mortgagor) <br />Billing Name <br />Connection <br />DATE <br />Utility Account No. <br />Connection Permit Fee <br />Connection Fee <br />Total Fee <br />Signed <br />Customer <br />DESCRIPTION: Sewer District <br />Lot 2l, 2�, Z 3 <br />Block�2�1 Monthly Sewer Service <br />Division or Addition L E� �� �� lar l� Monthly Sewer Constr. <br />Type Permit: <br />SEE SKETCh' ATTACHED <br />Trunk <br />Latera <br />Abutting Lot Line <br />N, S, E, W ft. <br />Approved By_. <br />City Enginrer <br />I SSU C(J <br />Inspection By ,ll(�• 7'�-�T'���"'� <br />Datelnspected 2 Z 7{ _ <br />NO. `'i(l ��� <br />