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everett <br /> S Gl <br /> City of '=verett <br /> Engineeri,ig Department <br /> Sewer Application and Permit <br /> NO. DATE <br /> Service Address_---- -- Utility Account No. <br /> Billing Address---- --. Connection Permit Fee <br /> City,State, Zip <br /> Connection Fee <br /> Owner (Mortgagor) Total Fee <br /> Billing Name <br /> Connection By - - <br /> Address------ Signed cmiomet , <br /> Phone — <br /> DESCRIPTION: Sewer District <br /> Lot Monthly Sewer Service <br /> Block_ <br /> Monthly Sewer Constr. <br /> Division or Addition <br /> Trunk <br /> Type Permit: <br /> Lateral <br /> Remarks: Abutting Lot Line <br /> N, S, E, W ft. <br /> a <br /> Approved By Clty Enpinea <br /> Issu=d By <br /> Inspection By AQom- <br /> Date I nspectedd?12� <br /> SEE SKETCH ATTACHED No. 21361 <br /> i <br />