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eD <br />City of Everett <br />Engineering Department <br />Sewer Application and Permit <br />No. 21393 DATE <br />Service A.ldress _ <br />Utility Account No. <br />Billing Address <br />Connection Permit Fee_ <br />City, State, Zip <br />Connection Fee <br />Owner (Mortgagor) <br />_ Total Fee_ <br />Billing Name <br />Connection By <br />Address <br />Signed <br />Custor <br />Phone <br />DESCRIPTION: <br />Sewer District <br />Lot _ <br />Block <br />Monthly Sewer Service <br />Division or Addition. <br />Monthly Sewer Constr. <br />"fvpe Permit: <br />Trunk <br />SEE SKETCH ATTACHED <br />INSPECTION <br />Lateral <br />Abutting Lot Line <br />N, S, E, W. <br />Approveo By <br />City Engineer <br />Issued <br />In wction By <br />Date Inspected �Z 7L <br />No. 21393 <br />