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everett <br />City of Everett <br />Engineering Department <br />Sewer Application and Permit <br />NO, DATE <br />Service <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor(____ <br />Billing <br />Connection <br />Phone <br />DESCRIPTION: <br />Lot <br />Block <br />Division or Add <br />Type Permit: e'n,,,, t =r,,, <br />Remarks: <br />a <br />SEE SKETCH ATTACHED <br />', i I : I I I ' t A <br />Utility Account No. 3 - 2-3- 241 — o O <br />� <br />Connection Permit Fee 3 o' <br />/-95�� Po 9/9/74 <br />Connection Fee_ <br />Total <br />Signed <br />Sewer <br />Mon -lily Sewer Service_ <br />Monthly Sewer Constr. <br />Trunk <br />Lateral <br />Abutting Lot Line <br />N, S, E, W, <br />Approved By — <br />City Engineer <br />Issued By <br />c <br />Inspection By � `mow--J <br />Date Inspected <br />i <br />No. 2].421 <br />