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I t.vere11 I <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Permit <br />NO. A 21. l0 DATE <br />eX 2- <br />Service Address f <br />Billing Address t. t <br />City, State, Zip t•g + '�t to �i I L L t_ <br />Owner (Mortgagor) L I < <br />Billing Name ti I c. <br />Connection By i t-t• <br />Address _I C ( �_; .1 7 t \. L- <br />CHART NO��A <br />�O S i^GrlJ <br />Utility Account No. <br />Permit Fee <br />Connection Charge( <br />Total Fee <br />Signed <br />' Customer <br />DESCRIPTION: Sewer District � `-• <br />C L....) <br />Lot Block Monthly Sewer Service <br />Plat' _ t.,,t- t +_ -t. I , � � <br />Unplatted Description Monthly Sewer Constr. <br />Type Permit: ►�(_ (y ,, Trunk <br />Lateral <br />Remarks: <br />Abutting Lot Line <br />n I'N S, E. W <br />Approved By L L L.L +�, .nJ <br />Gty Engineer <br />-- Issued By. <br />— -- Inspection By_ <br />Date Inspected /J/% <br />0 <br />SEE SKETCH ATTACHED NO. <br />