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i <br />evere" <br />le <br />City of Everett <br />Engineering Department <br />t/� 7J� 7T-- JAW <br />Sewer Application and Permit <br />i IZ, <br />NO. 2100a. DATE <br />Service Address �4 7-�,:. - � y <br />Billing Address <br />City, State, Zip ' 614e S 4-- /%— <br />Owner(Mortgagor) <br />Billing Name <br />Connection By <br />Phone <br />DESCRIPTION: <br />Lot _ <br />Utility Account No. <br />Connection Permit Fee S C ) <br />Connection <br />Total F <br />Signed <br />Customer <br />Sewer D <br />Block I Monthly Sewer Service <br />Division or Addition % 1�.<- /' Monthly Sewer Constr. <br />SEE SKETCH ATTACHED <br />INSPECTION <br />Trunk <br />Lateral <br />Abutting Lot Line <br />N, S, E, W_ <br />Approved By <br />City Eugiteer <br />Issued By_ <br />Inspection By <br />Date Inspected _ <br />No. 21008 <br />