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0 <br />everett <br />City of Everett <br />Engineering Department <br />Sewer Application and Permit <br />No. 21235 DATE <br />Service Address_ <br />Billing Address_ <br />City, State, Zip_ <br />Owner (Mortgage <br />Billinq Name_ <br />Connection By_ <br />Address_ <br />Phone -- <br />DESCRIPTION: <br />Lot <br />Division or Addition <br />Tvne Permit: <br />7 <br />SEE SKETCH ATTACHED <br />u�I:�PEGIION <br />Utility Account No._ <br />Connection Permit F <br />Connection Fee_ <br />Total Fee <br />Signed <br />Sewer District <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Trunk — <br />Abutting Lot Line <br />N, S, E, W <br />Approved <br />Issued <br />Inspection By_ <br />Date Inspected <br />Engineer <br />No. 21235 <br />