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Li <br />I <br />City of Everett <br />En .spring Departn•ent <br />Sever Application and Permit <br />NO. DATE N") 3 /9%D <br />Service Address / / <br />Billing Address <br />City, State, Zip — <br />Owner (Mortgagor) — <br />Billing Name <br />Connection By_ <br />DESCRIPTION: <br />Lot -n 1W— <br />Block <br />Division or Addition _ <br />Type Permit: t <br />YP �/ %nw 1 � � wit i <br />ilrmarks: <br />SEE SKETCH ATTACHED <br />Utility Account No. d 37-01J <br />Connection Permit ree <br />Connection Fee <br />Total Fee -- <br />Signed <br />Cufiomer <br />Sewer District ,'� y rr— -a/ �L:— <br />Monthly Sewer Service -- <br />Monthly Sewer Constr. <br />Trunk / / 5" <br />Abutting Lot Line <br />N,S,E,W <br />Approved By <br />city 9npinen <br />Issued <br />Inspection By '�t*r <br />Date Inspected <br />N0. 21.512 <br />