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c vcrt ttL- - / S — Z ra <br />Lq J <br />City of Everett <br />Engineering Department <br />Sewer Application and Permit <br />NO. 20 9 1 E DATE <br />Service Address <br />Billing Address <br />City, State, Zip % ,it x eF <br />Owner (Mortgagor)_'_,//!_( r 1;i —LC� <br />Billing Name 17L <br />Connection By_ U J, ( <br />Utility Account No. <br />Connection Permit Fee r ; <br />Connection Fee__ <br />Tctal Fee), (� ) <br />Signed <br />Customer <br />DESCRIPTION: Sewer District_- <br />Lot <br />Block. � <br />Monthly Sewer Service <br />Division or Addition.' Nl A�S�1.t/ `; ! ;� -i) L Monthly Sewer Constr. <br />Type Permit: <br />Remarks: <br />SEE SKETCH ATTACHED <br />Tr <br />Lateral <br />Abutting Lot Line <br />N,S,E,W <br />Approved By__ <br />Gay Engmeer <br />Issued By <br />Inspection By <br />Da, a Inspected — 3 — 2- <br />NO. ?((976 <br />