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vereli � <br />7 � v <br />�� <br />City of Everett <br />Engineering Department <br />Sewer Application and Permit <br />No. 20981 DATE <br />Service Address -- <br />Billing Address <br />City, State, Zip _ 1- f x & <br />i <br />Owner (Mortgagor) '�� A% <br />Billing Name <br />Connection By_ <br />Utility Account No. <br />Connection Permit Fee <br />Connection Fee <br />Total Fee '1 <br />Signed <br />Customer <br />DESCRIPTION: Sewer District <br />Lot Monthly Sewer Service <br />Block_ <br />Division or Addition ' W G! trenjl r- �( ! i'- I Monthly Sewer Constr. <br />0 <br />SEE SKETCH ATTACHED <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />Approved By_ <br />Cdy Engineer <br />Issued <br />Inspection By e -a ' 1 <br />Date Inspected "z 3 <br />NO. r2 (1 c) 8, j. <br />