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eVV `etf <br />City of Everett <br />Engineering Department <br />Sewer Application and Permit <br />NO. 21335 DATE — — <br />6ervice Address <br />___. Utility Account No <br />Billing Address _ <br />Connection Permit <br />City, State, Zip <br />Connection Fee_. <br />Owner (Mortgagor) <br />Total Fee__ <br />Billing Name <br />Connection By <br />Address <br />Signed— <br />Phone — <br />DESCRIPTION: Sewer District <br />Lot Monthly Sewer Service <br />Block_ <br />Division or Addition_ Monthly Sewer Constr. <br />_. Trn nL <br />Tvoe Permit: <br />171 <br />SEE SKETCH ATTACHED <br />Abutting Lot Line <br />N, S. E, W <br />Approved <br />Issued By_ <br />Inspection By —A <br />Date Insoected = <br />No. 21335 <br />