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W <br />City of Everett <br />Engineering Department <br />Sewer Application and Permit <br />NO. <br />DATE <br />Service 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 />— <br />A,irirecc - -------- <br />Signed <br />Phone <br />DESCRIPTION: Sewer District <br />Lot Monthly Sewer Service. <br />Block_ <br />Division or Addition — Monthly Sewer Constr. <br />Type Permit: <br />Remarks: <br />SEE SKETCH ATTACHED <br />1, <br />Abutting Lot Line <br />N, S, E, W <br />Approved By <br />CIly Engineer <br />Issued <br />Inspection By <br />Date Inspected �7 <br />No. 2157G <br />ft. <br />